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South Dakota rates for HCPCS J9281

Mitomycin pyelocalyceal instillation, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.52 / $318.52 / $318.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.52 / $318.52 / $384.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.52 / $318.89 / $398.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$317.42 / $536.44 / $634.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.42 / $353.36 / $1,374.70
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.63 / $405.06 / $526.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.59 / $467.03 / $476.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.58 / $348.58 / $348.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.52 / $318.52 / $379.05
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.37 / $347.37 / $347.37
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$347.37 / $347.37 / $347.37