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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
$75.86 / $75.86 / $151.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $128.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $97.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $131.83 / $213.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $77.62 / $79.43
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $93.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $83.18 / $83.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $83.18
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $79.43 / $79.43