go back

South Dakota rates for HCPCS J1322

Injection, elosulfase alfa, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$308.68 / $308.68 / $308.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.68 / $308.68 / $371.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$314.51 / $314.51 / $314.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.48 / $308.68 / $374.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$345.12 / $438.72 / $840.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.94 / $306.80 / $337.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.71 / $368.15 / $514.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.20 / $352.72 / $640.34
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.43 / $337.80 / $337.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.68 / $308.68 / $339.55
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.80 / $306.80 / $306.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.80 / $306.80 / $306.80