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South Dakota rates for HCPCS J0122

Injection, eravacycline, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.30 / $1.30 / $1.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.30 / $1.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.24 / $1.33 / $1.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.40 / $1.84 / $3.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.21 / $1.29 / $1.42
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.45 / $2.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.43 / $1.43 / $1.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.30 / $1.43
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.29 / $1.29 / $1.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.29 / $1.29