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South Dakota rates for HCPCS J9293

Injection, mitoxantrone HCl, per 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.88 / $23.88 / $23.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.88 / $23.88 / $35.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.24 / $28.52 / $35.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.60 / $50.02 / $310.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.60 / $32.95 / $1,372.11
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.22 / $65.26 / $91.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.22 / $49.42 / $73.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.13 / $26.13 / $366.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.88 / $23.88 / $28.42
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.39 / $32.39 / $32.39
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.39 / $32.39 / $32.39