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South Dakota rates for HCPCS J0742

Injection Imipenem 4 Mg Cilastatin 4 Mg And Relebactam 2 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $3.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $2.61 / $3.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.00 / $3.73 / $7.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.61 / $2.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.00 / $3.13 / $4.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.85 / $3.00 / $5.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.85 / $2.85 / $2.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.61 / $2.87
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61