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South Dakota rates for HCPCS J2515

Injection, pentobarbital sodium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.38 / $63.38 / $63.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.61 / $63.38 / $63.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.03 / $28.78 / $28.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.15 / $72.50 / $156.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.79 / $52.82 / $58.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.15 / $30.51 / $57.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.15 / $34.36 / $57.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.10 / $43.10 / $43.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.82 / $52.82 / $58.10
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.83 / $52.83 / $52.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.83 / $52.83 / $52.83