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South Dakota rates for HCPCS J0291

Injection, plazomicin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.50 / $3.50 / $3.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.50 / $3.50 / $4.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.64 / $3.64 / $4.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.15 / $5.11 / $9.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.50 / $3.57 / $3.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.29 / $4.29 / $6.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.07 / $4.29 / $8.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.84 / $3.84 / $3.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.50 / $3.50 / $3.85
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.57 / $3.57 / $3.57
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.57 / $3.57 / $3.57