go back

South Dakota rates for HCPCS J0696

Injection, ceftriaxone sodium, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.21 / $135.13 / $351.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.94 / $23.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.53 / $0.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.69 / $4.05 / $64.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.48 / $0.53
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $0.59 / $0.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $0.67 / $0.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $14.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.43 / $0.47
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48