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South Dakota rates for HCPCS J2425

Injection, palifermin, 50 mcg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $36.31 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $61.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $37.15 / $46.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $51.29 / $97.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $36.31 / $36.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $42.66 / $42.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $39.81 / $39.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $36.31 / $40.74
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.48 / $35.48 / $35.48