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South Dakota rates for HCPCS J7307

Etonogestrel (contraceptive) implant system, including implant and supplies

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,214.63 / $1,214.63 / $1,214.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$920.00 / $1,214.63 / $1,402.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.63 / $1,226.77 / $1,518.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,260.21 / $2,052.71 / $5,203.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,032.44 / $1,214.63 / $1,360.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,302.85 / $1,302.85 / $1,302.85
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,302.85 / $1,302.85 / $1,312.05
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.04 / $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