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South Dakota rates for HCPCS J2503

Pegaptanib Sodium Injection

Insurance Carrier
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.25 / $800.25 / $1,000.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,089.17 / $1,089.17 / $1,743.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.25 / $889.25 / $978.18
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.06 / $1,168.16 / $1,722.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.98 / $1,132.27 / $1,722.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.25 / $889.25 / $978.18