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South Dakota rates for HCPCS J0256

Injection, alpha 1-proteinase inhibitor (human), not otherwise specified, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.46 / $5.46 / $5.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.24 / $5.46 / $6.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.55 / $5.55 / $5.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.46 / $6.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.89 / $7.72 / $14.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.16 / $5.19 / $5.71
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $6.22 / $8.91
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $5.86 / $7.64
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.14 / $5.97 / $5.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.46 / $5.46 / $6.01
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.19 / $5.19 / $5.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.19 / $5.19 / $5.19