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South Dakota rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.06 / $0.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.06 / $0.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03