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South Dakota rates for HCPCS J9313

Injection Moxetumomab Pasudotox-Tdfk 0.01 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.48 / $26.48 / $26.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.18 / $22.51 / $26.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.85 / $24.09 / $29.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.39 / $35.79 / $47.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.07 / $24.57 / $100.62
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.07 / $33.21 / $40.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.07 / $31.28 / $38.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.51 / $22.51 / $22.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.07 / $22.07 / $24.57
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.60 / $25.60 / $25.60
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.60 / $25.60 / $25.60