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South Dakota rates for HCPCS J9325

Injection, talimogene laherparepvec, per 1 million plaque forming units

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $72.44 / $147.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $75.86 / $93.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $147.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $81.28 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $91.20 / $109.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $81.28 / $81.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $83.18 / $87.10
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $81.28 / $81.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $81.28 / $81.28