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South Dakota rates for HCPCS J0456

Azithromycin

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $110.62 / $205.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.04 / $3.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.29 / $2.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.54 / $4.41 / $26.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.61 / $2.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.54 / $3.14 / $4.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $3.14 / $4.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.23 / $2.23 / $2.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.04 / $2.81
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61