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South Dakota rates for HCPCS J2670

Injection Tolazoline Hcl Up To 25 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.13 / $4.13 / $4.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.43 / $4.13 / $4.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.75 / $3.75 / $4.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.72 / $5.55 / $10.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.13 / $4.13 / $4.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.54 / $4.54 / $4.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.13 / $4.13 / $5.45