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South Dakota rates for HCPCS J9205

Injection, irinotecan liposome, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $66.00 / $66.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.00 / $66.65 / $78.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.00 / $66.53 / $83.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.26 / $110.29 / $130.52
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.26 / $72.65 / $283.51
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.44 / $85.38 / $108.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.44 / $85.38 / $98.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.22 / $72.22 / $72.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.00 / $66.00 / $73.47
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.41 / $71.41 / $71.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.41 / $71.41 / $71.41