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South Dakota rates for HCPCS J3355

Injection, urofollitropin, 75 IU

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.18 / $150.18 / $150.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.65 / $150.18 / $150.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.25 / $65.25 / $81.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.03 / $202.20 / $370.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.19 / $125.15 / $137.66
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.03 / $76.18 / $112.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.03 / $99.63 / $159.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.38 / $125.15 / $137.66