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South Dakota rates for HCPCS J9017

Injection, arsenic trioxide, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.15 / $8.15 / $8.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.09 / $8.15 / $9.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.88 / $6.09 / $8.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.86 / $9.90 / $45.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.86 / $6.52 / $7,072.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $7.19 / $106.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $17.51 / $81.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.92 / $8.92 / $38.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.15 / $8.15 / $9.69
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.41 / $6.41 / $6.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.41 / $6.41 / $6.41