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South Dakota rates for HCPCS J1260

Injection, dolasetron mesylate, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.04 / $7.04 / $7.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.84 / $7.04 / $7.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $6.38 / $7.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.26 / $10.71 / $17.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.56 / $12.20 / $13.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.26 / $4.58 / $6.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.26 / $6.76 / $10.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.93 / $3.93 / $3.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.20 / $12.20 / $13.58