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South Dakota rates for HCPCS J0221

Injection, alglucosidase alfa, (Lumizyme), 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.59 / $206.59 / $206.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.59 / $206.59 / $250.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.49 / $210.49 / $210.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.39 / $206.59 / $256.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.84 / $295.47 / $566.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.57 / $206.62 / $227.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.68 / $247.94 / $352.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.36 / $229.87 / $302.45
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.03 / $226.08 / $226.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.56 / $206.59 / $227.25
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.62 / $206.62 / $206.62
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.62 / $206.62 / $206.62