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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
$4.01 / $4.01 / $4.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $4.01 / $4.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.94 / $4.09 / $4.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.70 / $5.73 / $10.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.87 / $4.01 / $4.41
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.63 / $4.80 / $6.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.42 / $4.63 / $8.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.40 / $4.40 / $4.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $4.01 / $4.01
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.01 / $4.01 / $4.01
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $4.01 / $4.01