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South Dakota rates for HCPCS J0224

Oxlumo SC SOLN 94.5 MG/0.5ML

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.05 / $329.05 / $329.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.05 / $329.05 / $398.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.25 / $335.25 / $335.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.86 / $328.11 / $406.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.58 / $556.17 / $901.73
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.85 / $329.10 / $362.01
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.62 / $436.15 / $556.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.53 / $382.62 / $477.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.10 / $360.10 / $360.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.01 / $329.05 / $361.96
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.10 / $329.10 / $329.10
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.10 / $329.10 / $329.10