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South Dakota rates for HCPCS J2680

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.31 / $7.31 / $7.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.31 / $7.31 / $9.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.00 / $9.00 / $11.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.77 / $12.73 / $37.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.31 / $7.53 / $8.83
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.03 / $11.29 / $22.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.59 / $13.97 / $27.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.99 / $7.99 / $7.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.31 / $7.31 / $8.03
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.53 / $7.53 / $7.53
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.53 / $7.53 / $7.53