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South Dakota rates for HCPCS J0717

Injection, certolizumab pegol, 1 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self-administered)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.91 / $3.91 / $3.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.91 / $3.95 / $5.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $3.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.05 / $4.05 / $5.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.68 / $7.59 / $15.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.91 / $4.49 / $4.94
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.68 / $5.85 / $9.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.48 / $6.08 / $9.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.28 / $4.28 / $15.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.90 / $3.91 / $4.30
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.49 / $4.49 / $4.49
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.49 / $4.49 / $4.49