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South Dakota rates for HCPCS J1726

Injection Hydroxyprogesterone Caproate (Makena) 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.26 / $24.26 / $24.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.14 / $24.26 / $24.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.00 / $33.00 / $41.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.26 / $31.22 / $59.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.64 / $19.64 / $21.62
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.73 / $20.73 / $24.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $23.61
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.62 / $20.62 / $20.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.70 / $19.64 / $20.23
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.64 / $19.64 / $19.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.64 / $19.64 / $19.64