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South Dakota rates for HCPCS J2730

Injection Pralidoxime Chloride Up To 1 Gm (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.04 / $104.04 / $104.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.35 / $104.04 / $104.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.50 / $94.50 / $118.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.72 / $133.91 / $256.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.93 / $86.70 / $95.37
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.72 / $101.57 / $149.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.72 / $111.31 / $204.11
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.43 / $88.43 / $88.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.70 / $86.70 / $95.37
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.70 / $86.70 / $86.70
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.70 / $86.70 / $86.70