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South Dakota rates for HCPCS J3105

Injection Terbutaline Sulfate Up To 1 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.77 / $7.39 / $104.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.32 / $7.39 / $8.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.43 / $1.78 / $1.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.43 / $4.63 / $41.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $2.74 / $7.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $2.94 / $4.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $3.21 / $4.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.09 / $8.09 / $8.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.39 / $7.39 / $8.13
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.74 / $2.74 / $2.74
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.74 / $2.74 / $2.74