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South Dakota rates for HCPCS J9219

Leuprolide acetate implant, 65 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,819.82 / $4,819.82 / $4,819.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,855.86 / $4,096.85 / $4,819.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,001.75 / $5,001.75 / $6,252.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,004.97 / $6,516.40 / $8,675.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,684.00 / $6,327.49 / $6,763.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $0.90 / $6,748.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.13 / $6,000.51 / $7,229.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,684.00 / $5,684.00 / $6,960.24