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South Dakota rates for HCPCS J9202

Goserelin acetate implant, per 3.6 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$733.67 / $2,304.32 / $2,831.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.67 / $741.00 / $888.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.46 / $733.67 / $898.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$261.39 / $1,049.83 / $1,783.73
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.15 / $817.26 / $3,104.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$273.00 / $913.98 / $1,101.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.30 / $846.17 / $1,101.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.00 / $802.88 / $1,159.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.67 / $733.67 / $873.07
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.41 / $803.41 / $803.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$803.41 / $803.41 / $803.41