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South Dakota rates for HCPCS J1729

Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.37 / $16.37 / $16.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.59 / $16.37 / $550.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.38 / $15.38 / $19.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.37 / $21.06 / $40.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.64 / $13.64 / $15.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.39 / $16.39 / $16.39
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.72 / $15.72 / $15.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.64 / $13.64 / $15.00
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.64 / $13.64 / $13.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.64 / $13.64 / $13.64