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South Dakota rates for HCPCS J1950

Injection, leuprolide acetate (for depot suspension), per 3.75 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,730.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,747.63 / $2,180.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,701.83 / $1,730.32 / $2,127.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,563.42 / $2,484.05 / $4,759.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,859.39 / $1,933.76
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,219.61 / $2,084.52 / $2,916.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$989.39 / $1,900.12 / $2,500.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.25 / $1,893.56 / $1,893.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.32 / $1,730.32 / $1,926.21
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.10 / $1,737.10 / $1,737.10
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.10 / $1,737.10 / $1,737.10