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South Dakota rates for HCPCS J0713

Injection Ceftazidime Per 500 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.57 / $1.57 / $1.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.57 / $1.59 / $2.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.61 / $2.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.98 / $2.77 / $4.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.57 / $1.64 / $1.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.92 / $1.98 / $3.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.90 / $2.38 / $3.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.72 / $1.72 / $1.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.57 / $1.57 / $1.73
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $1.64 / $1.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.64 / $1.64 / $1.64