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South Dakota rates for HCPCS J0121

Injection, omadacycline, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $8.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $3.98 / $7.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $4.27 / $5.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.68 / $5.75 / $10.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.39 / $3.98 / $3.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $4.47 / $4.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $4.17 / $4.57
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $3.98