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South Dakota rates for HCPCS J0694

Injection, cefoxitin sodium, 1 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.78 / $83.22 / $192.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.83 / $6.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.09 / $5.09 / $6.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.34 / $8.67 / $132.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $5.13 / $5.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.34 / $6.12 / $6.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $6.10 / $6.68
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.23 / $5.23 / $5.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $5.26
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.13 / $5.13 / $5.13
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $5.13 / $5.13