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South Dakota rates for HCPCS J1956

Injection, levofloxacin, 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $9.94 / $272.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $2.54 / $2.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.06 / $1.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $3.31 / $96.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.96 / $2.54
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.23 / $1.57 / $2.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.17 / $1.57 / $2.95
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.77 / $2.77 / $2.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.16 / $2.54 / $2.79
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.96 / $1.96 / $1.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.96 / $1.96 / $1.96