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South Dakota rates for HCPCS J3410

Injection Hydroxyzine Hcl Up To 25 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.30 / $242.01 / $242.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.30 / $15.30 / $20.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.07 / $18.07 / $22.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.69 / $28.61 / $46.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.30 / $16.93 / $18.62
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.54 / $15.29 / $21.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $14.03 / $21.31
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.62 / $16.73 / $16.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.30 / $15.30 / $16.82
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.93 / $16.93 / $16.93
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.93 / $16.93 / $16.93