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South Dakota rates for HCPCS J7121

5% Dextrose In Lac Ringers

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.58 / $9.58 / $153.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.95 / $9.58 / $9.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.99 / $8.07 / $9.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.58 / $12.33 / $153.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.98 / $7.98 / $7.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.78 / $8.78 / $8.78
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.14 / $8.14 / $8.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.98 / $7.98 / $7.98
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.98 / $7.98 / $7.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.98 / $7.98 / $7.98