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South Dakota rates for HCPCS J1580

Garamycin Gentamicin Inj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.21 / $75.23 / $339.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.21 / $2.22 / $3.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.50 / $3.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.96 / $4.43 / $28.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.21 / $2.62 / $2.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.84 / $2.96 / $3.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $2.85 / $3.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.41 / $2.41 / $2.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.21 / $2.21 / $2.43
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.62 / $2.62 / $2.62
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.62 / $2.62 / $2.62