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South Dakota rates for HCPCS J2779

Injection Ranibizumab Via Intravitreal Implant (Susvimo) 0.1 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.93 / $78.93 / $78.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.93 / $79.22 / $94.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.23 / $81.23 / $101.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.00 / $132.55 / $214.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.43 / $78.43 / $86.27
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.12 / $120.69 / $167.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.72 / $95.68 / $167.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.39 / $86.39 / $86.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.93 / $78.93 / $86.82
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.43 / $78.43 / $78.43
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.43 / $78.43 / $78.43