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South Dakota rates for HCPCS J0515

Injection Benztropine Mesylate Per 1 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.33 / $15.33 / $15.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.33 / $15.33 / $20.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.10 / $17.10 / $21.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.27 / $29.19 / $47.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.33 / $17.27 / $19.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.12 / $20.72 / $29.06
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.45 / $22.50 / $29.06
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.77 / $16.77 / $16.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.03 / $15.33 / $16.86
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.27 / $17.27 / $17.27
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.27 / $17.27 / $17.27