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South Dakota rates for HCPCS J0490

Injection, belimumab, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $57.54 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $57.54 / $97.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $57.54 / $57.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $58.88 / $72.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $79.43 / $154.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $56.23 / $56.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $67.61 / $67.61
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $63.10 / $63.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $57.54 / $63.10
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $56.23 / $56.23