go back

South Dakota rates for HCPCS J9295

Injection Necitumumab 1 Mg (Reinstated 01/01/2017). Polyestradiol Phosphate 40 Mg (Del 03/31/2003).

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.73 / $5.73 / $5.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.73 / $5.73 / $6.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.85 / $5.91 / $7.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.73 / $9.68 / $11.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.73 / $6.38 / $25.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.88 / $8.14 / $10.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.88 / $8.14 / $9.47
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.28 / $6.28 / $6.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.73 / $5.73 / $6.82
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.27 / $6.27 / $6.27
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.27 / $6.27 / $6.27