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South Dakota rates for HCPCS J0215

Injection, alefacept, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.28 / $28.28 / $28.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.07 / $28.28 / $39.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.25 / $47.25 / $59.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.28 / $37.29 / $63.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.23 / $47.14 / $51.85
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.28 / $32.47 / $47.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.28 / $45.81 / $65.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.14 / $47.14 / $51.85