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South Dakota rates for HCPCS J9395

Injection, fulvestrant, 25 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.73 / $7,503.17 / $7,503.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $6.79 / $8.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.01 / $7.08 / $8.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.98 / $11.80 / $107.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.98 / $7.77 / $2,103.23
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.27 / $10.34 / $144.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.27 / $19.89 / $142.94
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.37 / $7.37 / $81.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $7.49 / $8.01
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.64 / $7.64 / $7.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.64 / $7.64 / $7.64