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South Dakota rates for HCPCS J9040

Injection, bleomycin sulfate, 15 units

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.53 / $21.53 / $21.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.53 / $21.73 / $64.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.98 / $22.19 / $27.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.90 / $35.32 / $57.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.90 / $78.20 / $971.75
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.87 / $31.37 / $37.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.87 / $31.82 / $69.75
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.56 / $23.56 / $434.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.53 / $21.53 / $78.20
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.87 / $22.87 / $22.87
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.87 / $22.87 / $22.87