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South Dakota rates for HCPCS J9201

Injection, gemcitabine HCl, not otherwise specified, 200 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $119.07 / $119.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.13 / $3.16 / $7.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.04 / $3.13 / $3.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.96 / $5.00 / $142.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.96 / $38.36 / $502.47
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.57 / $4.30 / $9.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.57 / $4.68 / $10.36
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.42 / $3.42 / $149.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.87 / $3.13 / $38.36
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.24 / $3.24 / $3.24
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.24 / $3.24 / $3.24