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South Dakota rates for HCPCS J0695

Injection, ceftolozane 50 mg and tazobactam 25 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.07 / $9.07 / $9.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.07 / $9.07 / $11.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.21 / $9.07 / $10.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.70 / $13.06 / $25.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.03 / $9.13 / $10.03
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.08 / $9.77 / $14.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.49 / $9.39 / $16.78
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.92 / $9.92 / $9.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.07 / $9.07 / $9.98
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.13 / $9.13 / $9.13
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.13 / $9.13 / $9.13