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South Dakota rates for HCPCS J1430

Injection, ethanolamine oleate, 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$508.96 / $508.96 / $508.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.96 / $508.96 / $628.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.08 / $508.96 / $633.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$589.98 / $742.91 / $1,423.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.70 / $519.52 / $571.47
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$532.91 / $623.41 / $860.39
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.01 / $560.48 / $737.48
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$556.97 / $556.97 / $556.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$491.65 / $508.96 / $559.86
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$519.52 / $519.52 / $519.52
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.52 / $519.52 / $519.52