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South Dakota rates for HCPCS J0207

Injection, amifostine, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,285.69 / $1,285.69 / $1,285.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.55 / $1,092.83 / $1,285.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,092.83 / $1,157.25 / $1,446.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$600.99 / $1,470.83 / $2,314.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.41 / $1,192.70 / $4,885.62
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.00 / $550.36 / $1,240.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.36 / $805.00 / $1,584.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.47 / $1,092.83 / $1,092.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.41 / $1,071.41 / $1,192.70
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.41 / $1,071.41 / $1,071.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.41 / $1,071.41 / $1,071.41