go back

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
$7.94 / $7.94 / $17.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $15.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $9.12 / $11.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $13.18 / $25.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.76 / $9.12 / $9.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $10.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $9.77 / $9.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $8.91 / $9.77
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.12 / $9.12 / $9.12