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South Dakota rates for HCPCS J0257

Glassia Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.64 / $5.64 / $5.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.64 / $6.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.74 / $5.74 / $5.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.55 / $5.64 / $6.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.61 / $8.17 / $15.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.45 / $5.71 / $6.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.56 / $6.86 / $9.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.74 / $6.28 / $8.27
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $6.17 / $6.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.64 / $6.20
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.71 / $5.71 / $5.71
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.71 / $5.71 / $5.71