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South Dakota rates for HCPCS J0475

Injection, baclofen, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $181.97 / $363.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $181.97 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $186.21 / $229.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $281.84 / $478.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $177.83 / $181.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $208.93
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $199.53 / $199.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $181.97 / $229.09
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $181.97 / $181.97