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South Dakota rates for HCPCS J2425

Injection Palifermin 50 Micrograms

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.54 / $35.54 / $35.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.54 / $35.54 / $43.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.65 / $35.00 / $43.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.62 / $51.35 / $98.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.99 / $35.90 / $39.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.99 / $40.79 / $59.48
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.84 / $35.67 / $50.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.34 / $38.90 / $38.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.54 / $35.54 / $39.11
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.90 / $35.90 / $35.90
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.90 / $35.90 / $35.90