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South Dakota rates for HCPCS J1205

Injection, chlorothiazide sodium, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $48.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.08 / $39.45 / $41.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.74 / $72.56 / $194.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.47 / $40.38 / $44.42
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.97 / $48.46 / $79.70
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.37 / $69.61 / $158.32
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.16 / $43.16 / $43.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $43.40
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.38 / $40.38 / $40.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.38 / $40.38 / $40.38