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South Dakota rates for HCPCS J0572

Buprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.70 / $4.70 / $4.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.76 / $4.00 / $4.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.70 / $7.15 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.15 / $6.51 / $7.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $1.60 / $1.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $4.90 / $4.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.73 / $6.36 / $7.00
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.22 / $1.22 / $1.22
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.22 / $1.22