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South Dakota rates for HCPCS J0574

Buprenorphine/Naloxone Oral Greater Than 6 Mg But Less Than Or Equal To 10 Mg Buprenorphine (Revised 01/01/2016)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.31 / $9.31 / $9.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.45 / $7.91 / $9.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.31 / $14.16 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.94 / $9.94 / $11.73
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.39 / $2.39 / $2.39
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.76 / $8.76 / $8.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.75 / $9.77 / $10.76
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83