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South Dakota rates for HCPCS J3240

Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,116.32 / $2,116.32 / $2,116.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,030.00 / $2,137.48 / $2,557.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,117.92 / $2,117.92 / $2,647.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,098.00 / $3,021.93 / $5,790.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,078.71 / $2,113.23 / $2,324.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,877.10 / $2,535.89 / $3,618.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,718.17 / $2,357.42 / $3,101.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,004.98 / $2,315.96 / $2,315.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,798.87 / $2,116.32 / $2,116.32
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,113.23 / $2,113.23 / $2,113.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,113.23 / $2,113.23 / $2,113.23