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South Dakota rates for HCPCS J1743

Injection, idursulfase, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$558.46 / $558.46 / $558.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.46 / $558.46 / $675.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$568.99 / $568.99 / $568.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.83 / $558.46 / $691.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$557.74 / $874.69 / $1,530.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$542.57 / $558.55 / $614.41
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.16 / $670.27 / $948.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.64 / $651.09 / $813.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.15 / $611.15 / $611.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$542.22 / $558.46 / $614.30
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$558.55 / $558.55 / $558.55
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.55 / $558.55 / $558.55