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South Dakota rates for HCPCS J0289

Injection, amphotericin B liposome, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.48 / $21.48 / $21.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $27.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.74 / $23.74 / $29.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.77 / $38.22 / $61.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $22.62 / $24.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.90 / $28.77 / $41.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.70 / $27.60 / $37.42
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.51 / $23.51 / $23.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.26 / $21.48 / $23.63
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.62 / $22.62 / $22.62
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.62 / $22.62 / $22.62