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South Dakota rates for HCPCS J3260

Injection Tobramycin Sulfate Up To 80 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.37 / $2.37 / $27.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $2.39 / $2.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $2.02 / $2.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.14 / $4.16 / $6.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $2.46 / $2.71
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.91 / $2.36 / $3.17
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.95 / $4.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.60 / $2.60 / $2.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.37 / $2.60
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.46 / $2.46 / $2.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.46 / $2.46 / $2.46