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South Dakota rates for HCPCS J3250

Injection, trimethobenzamide HCl, up to 200 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.51 / $57.51 / $57.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.51 / $57.51 / $64.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $57.51 / $63.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.56 / $72.75 / $106.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.04 / $53.40 / $309.22
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.00 / $60.79 / $76.43
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.42 / $60.05 / $64.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.93 / $62.93 / $62.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.51 / $57.51 / $63.26
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.40 / $53.40 / $53.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.40 / $53.40 / $53.40