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South Dakota rates for HCPCS J0745

Injection Codeine Phosphate Per 30 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.09 / $1.09 / $1.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $1.09 / $1.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $1.52 / $1.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.15 / $1.44 / $2.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.97 / $1.52 / $1.67
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.15 / $1.26 / $1.85
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $1.72 / $2.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.52 / $1.52 / $1.67