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South Dakota rates for HCPCS J2720

Injection Protamine Sulfate Per 10 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.75 / $181.55 / $193.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.72 / $1.75 / $1.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.43 / $1.74 / $1.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $2.77 / $42.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.40 / $1.64 / $1.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.27 / $1.68 / $2.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.31 / $2.57
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.91 / $1.91 / $1.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.75 / $1.75 / $1.93
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $1.64 / $1.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.64 / $1.64 / $1.64