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South Dakota rates for HCPCS J0741

Injection, cabotegravir and rilpivirine, 2 mg/3 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.65 / $23.65 / $23.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.65 / $23.87 / $28.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.59 / $23.65 / $29.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.16 / $33.79 / $64.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.13 / $23.63 / $25.99
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.76 / $28.35 / $40.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.89 / $27.76 / $34.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.88 / $25.88 / $25.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.65 / $23.65 / $26.02
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.63 / $23.63 / $23.63
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.63 / $23.63 / $23.63