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South Dakota rates for HCPCS J2315

Injection, naltrexone, depot form, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.24 / $7,004.84 / $7,004.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $4.28 / $1,572.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.20 / $4.24 / $5.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.61 / $6.06 / $11.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.12 / $4.24 / $4.66
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.89 / $5.01 / $7.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.29 / $4.70 / $6.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.63 / $4.63 / $4.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $4.24 / $4.66
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.24 / $4.24 / $4.24
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $4.24 / $4.24