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South Dakota rates for HCPCS J0791

Injection Crizanlizumab-Tmca 5 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.47 / $129.47 / $129.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.47 / $130.87 / $163.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.93 / $131.93 / $131.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.93 / $131.93 / $164.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.18 / $185.30 / $355.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.47 / $129.58 / $142.54
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.41 / $155.49 / $225.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.69 / $155.40 / $319.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.69 / $141.69 / $141.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.47 / $129.47 / $142.43
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.58 / $129.58 / $129.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.58 / $129.58 / $129.58