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South Dakota rates for HCPCS J9120

Injection, dactinomycin, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$328.34 / $328.34 / $328.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.34 / $328.34 / $366.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.26 / $328.34 / $367.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.92 / $511.93 / $885.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.92 / $337.21 / $6,027.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.56 / $487.20 / $2,055.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.56 / $808.58 / $2,055.12
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.31 / $359.31 / $359.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.34 / $348.04 / $428.74
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.50 / $331.50 / $331.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.50 / $331.50 / $331.50