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South Dakota rates for HCPCS J2810

Injection, theophylline, per 40 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.47 / $0.49 / $0.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.15
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $0.54 / $0.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.45 / $0.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.15