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South Dakota rates for HCPCS J2543

Injection Piperacillin Sodium/Tazobactam Sodium 1 Gram/0.125 Grams (1.125 Grams) (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.07 / $79.80 / $281.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.12 / $1.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.59 / $2.84 / $16.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.11 / $1.22
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.36 / $3.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.82 / $3.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.17 / $1.17 / $1.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.18
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.11 / $1.11 / $1.11
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.11 / $1.11