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South Dakota rates for HCPCS J7298

Levonorgestrel-Releasing Intrauterine Contraceptive System (Mirena) 52 Mg (Desc Revised 1/1/2017)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.42 / $2,736.03 / $3,988.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,061.98 / $1,214.63 / $1,530.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,156.80 / $1,168.36 / $1,446.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$521.74 / $1,736.92 / $3,328.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.63 / $1,214.63 / $1,336.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,327.56 / $1,327.56 / $1,327.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,327.56 / $1,327.56 / $1,327.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,166.05 / $1,238.93 / $1,238.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.63 / $1,214.63 / $1,336.09
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,214.63 / $1,214.63 / $1,214.63
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.63 / $1,214.63 / $1,214.63