go back

South Dakota rates for HCPCS J3095

Injection, telavancin, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.11 / $7.11 / $7.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $9.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.24 / $7.24 / $9.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.88 / $10.94 / $20.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.09 / $7.47 / $8.22
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.09 / $8.96 / $12.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.97 / $8.43 / $11.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.78 / $7.78 / $7.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $7.82
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.47 / $7.47 / $7.47
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.47 / $7.47 / $7.47