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South Dakota rates for HCPCS J7313

Injection Fluocinolone Acetonide Intravitreal Implant (Iluvien) 0.01 Mg (Desc Rvsd 10/1/19)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$498.14 / $498.14 / $498.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.14 / $502.77 / $627.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.03 / $500.03 / $625.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.79 / $826.27 / $1,363.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.77 / $497.80 / $547.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.91 / $597.36 / $863.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.79 / $589.14 / $740.53
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.16 / $545.13 / $545.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.14 / $498.14 / $547.95
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$497.80 / $497.80 / $497.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.80 / $497.80 / $497.80