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South Dakota rates for HCPCS J9340

Thiotepa 15 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.68 / $252.17 / $312.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.10 / $266.10 / $266.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.49 / $2,184.00 / $2,184.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.88 / $332.63 / $439.62
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.35 / $321.18 / $492.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.17 / $268.17 / $268.17