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South Dakota rates for HCPCS J3415

Injection, pyridoxine HCl, 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.05 / $6.05 / $6.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.72 / $15.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.83 / $12.83 / $16.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.59 / $21.63 / $35.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.68 / $12.80 / $12.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.24 / $15.08 / $18.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.65 / $15.08 / $23.67
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.61 / $6.61 / $6.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.05 / $6.66
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.80 / $12.80 / $12.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.80 / $12.80 / $12.80