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South Dakota rates for HCPCS J0706

Injection, caffeine citrate, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.45 / $1.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.94 / $0.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $2.21 / $22.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.21 / $1.21 / $2.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.49 / $3.75 / $5.53
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $3.75 / $7.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.02 / $1.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.21 / $1.21 / $1.46
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00