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South Dakota rates for HCPCS J2407

Injection Oritavancin (Orbactiv) 10 Mg (Desc Rvsd 10/1/21)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.68 / $28.68 / $28.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.68 / $28.68 / $34.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.06 / $29.06 / $36.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.24 / $43.12 / $78.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.52 / $28.52 / $31.37
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.04 / $34.24 / $49.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.04 / $32.85 / $42.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.39 / $31.39 / $31.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.53 / $28.68 / $31.55
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $28.52 / $28.52
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.52 / $28.52 / $28.52