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South Dakota rates for HCPCS J1364

Injection, erythromycin lactobionate, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.62 / $64.62 / $64.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.62 / $64.62 / $90.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.20 / $67.20 / $84.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.56 / $107.32 / $205.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.62 / $75.05 / $82.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.56 / $79.15 / $104.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.48 / $79.15 / $104.55
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.62 / $64.62 / $71.08
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.05 / $75.05 / $75.05
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.05 / $75.05 / $75.05