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South Dakota rates for HCPCS J0287

Injection Amphotericin B Lipid Complex 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.30 / $10.30 / $10.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $10.30 / $12.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.50 / $10.50 / $13.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.03 / $17.41 / $28.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $10.30 / $11.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.36 / $14.48 / $21.73
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.12 / $13.10 / $20.51
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.28 / $11.28 / $11.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $10.30 / $11.33
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.30 / $10.30 / $10.30
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $10.30 / $10.30