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South Dakota rates for HCPCS J2765

Metoclopramide Hcl Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.70 / $66.88 / $144.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $1.10 / $1.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.43 / $61.22 / $255.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.11 / $1.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.08 / $1.24 / $1.50
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $1.20 / $1.55
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.18 / $1.18 / $2.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.09 / $1.21
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00