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South Dakota rates for HCPCS J0517

Injection, benralizumab, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.59 / $164.59 / $164.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.59 / $182.85 / $5,588.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.70 / $167.70 / $167.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.39 / $166.39 / $207.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.07 / $240.43 / $460.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.30 / $168.13 / $184.94
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.96 / $201.76 / $290.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.12 / $201.76 / $447.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.11 / $180.11 / $180.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.59 / $164.59 / $218.97
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.13 / $168.13 / $168.13
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.13 / $168.13 / $168.13