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South Dakota rates for HCPCS J2997

Alteplase Recombinant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.45 / $94.45 / $94.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.45 / $95.39 / $656.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.19 / $94.45 / $116.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.21 / $159.11 / $257.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.46 / $94.15 / $103.57
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.17 / $112.98 / $160.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.48 / $105.32 / $137.22
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.11 / $103.36 / $103.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.45 / $94.45 / $103.90
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.15 / $94.15 / $94.15
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.15 / $94.15 / $94.15