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South Dakota rates for HCPCS J3486

Injection, ziprasidone mesylate, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.83 / $6.83 / $6.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.17 / $6.83 / $6.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.29 / $6.61 / $6.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.49 / $8.60 / $26.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.14 / $3.14 / $6.83
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.77 / $8.63 / $26.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.22 / $10.79 / $26.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.47 / $7.47 / $7.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.83 / $6.83 / $7.51
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.14 / $3.14 / $3.14
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.14 / $3.14 / $3.14