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South Dakota rates for HCPCS J3315

Injection, triptorelin pamoate, 3.75 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$474.84 / $474.84 / $474.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.84 / $479.58 / $595.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.53 / $480.53 / $600.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$402.19 / $831.31 / $1,347.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.84 / $525.02 / $547.59
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.23 / $577.54 / $842.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.07 / $545.00 / $721.94
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.63 / $519.63 / $519.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.61 / $474.84 / $528.60
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$491.90 / $491.90 / $491.90
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$491.90 / $491.90 / $491.90