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South Dakota rates for HCPCS J0278

Injection, amikacin sulfate, 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.63 / $0.63 / $0.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $0.63 / $0.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.64 / $0.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.65 / $1.05 / $1.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.62 / $0.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.65 / $0.74 / $2.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $1.02 / $2.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.70 / $0.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $0.63 / $0.69
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $0.62 / $0.62
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $0.62 / $0.62