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South Dakota rates for HCPCS J0558

Injection, penicillin G benzathine and penicillin G procaine, 100,000 units

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.52 / $19.52 / $19.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.52 / $19.52 / $21.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.70 / $18.45 / $22.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.09 / $24.84 / $47.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.37 / $17.37 / $19.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.16 / $20.84 / $30.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.71 / $18.25 / $26.05
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.37 / $21.37 / $21.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.52 / $19.52 / $21.47
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.37 / $17.37 / $17.37
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.37 / $17.37 / $17.37