go back

South Dakota rates for HCPCS J0179

Inj, brolucizumab-dbll, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.11 / $346.11 / $346.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.11 / $349.56 / $418.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.39 / $346.39 / $432.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$406.67 / $495.05 / $948.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.99 / $346.19 / $380.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$406.67 / $415.43 / $593.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.49 / $407.99 / $822.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.76 / $378.76 / $378.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.89 / $346.11 / $380.72
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.19 / $346.19 / $346.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.19 / $346.19 / $346.19