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South Dakota rates for HCPCS J3304

Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.30 / $18.30 / $18.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.30 / $18.48 / $23.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.34 / $18.34 / $22.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.60 / $26.04 / $49.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.01 / $18.21 / $20.03
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.60 / $21.85 / $31.50
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.35 / $21.85 / $47.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.02 / $20.02 / $20.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.30 / $18.30 / $20.13
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.21 / $18.21 / $18.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.21 / $18.21 / $18.21