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South Dakota rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $2.58 / $71.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.70 / $0.86 / $2.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.86 / $1.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $1.07 / $1.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.61
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.49
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.49