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South Dakota rates for HCPCS J1595

Injection Glatiramer Acetate

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $75.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.25 / $75.00 / $75.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.50 / $70.50 / $88.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.20 / $114.08 / $1,863.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.50 / $62.50 / $1,552.63
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.36 / $1,998.26 / $2,947.37
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.64 / $2,189.84 / $4,015.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.95 / $183.95 / $183.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.50 / $62.50 / $68.75
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.50 / $57.50 / $57.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.50 / $57.50 / $57.50