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South Dakota rates for HCPCS J2504

Injection, pegademase bovine, 25 IU

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.56 / $416.56 / $416.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.74 / $416.56 / $416.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.00 / $375.00 / $468.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.54 / $536.11 / $1,027.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.62 / $357.54 / $393.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.54 / $198.99 / $523.53
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.54 / $335.47 / $477.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.54 / $357.54 / $393.29