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South Dakota rates for HCPCS J2460

Injection, oxytetracycline HCl, up to 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.10 / $1.10 / $1.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $1.10 / $1.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $1.48 / $2.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.94 / $0.94 / $1.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.10 / $1.10 / $1.78
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.38 / $1.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.94 / $0.94 / $1.03