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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
$181.22 / $181.22 / $181.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.22 / $181.22 / $212.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.09 / $181.22 / $222.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.21 / $279.31 / $481.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.80 / $175.82 / $193.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$201.61 / $210.98 / $304.22
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.24 / $209.03 / $260.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.31 / $198.31 / $216.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.22 / $181.22 / $199.34
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.82 / $175.82 / $175.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.82 / $175.82 / $175.82