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South Dakota rates for HCPCS J1458

Injection, galsulfase, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$508.76 / $508.76 / $508.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $508.76 / $611.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$518.36 / $518.36 / $518.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.03 / $508.76 / $617.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$513.77 / $722.88 / $1,385.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.88 / $505.51 / $556.05
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$448.57 / $581.91 / $613.82
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.50 / $552.80 / $727.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.35 / $556.75 / $556.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $508.76 / $559.64
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$505.51 / $505.51 / $505.51
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.51 / $505.51 / $505.51