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South Dakota rates for HCPCS J1955

Injection, levocarnitine, per 1 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.61 / $23.61 / $23.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $23.61 / $29.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.83 / $24.83 / $31.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.35 / $37.45 / $66.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.61 / $24.29 / $26.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.41 / $29.25 / $36.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.86 / $29.15 / $38.34
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.83 / $25.83 / $25.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.07 / $23.61 / $25.97
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.29 / $24.29 / $24.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.29 / $24.29 / $24.29