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South Dakota rates for HCPCS J0850

Injection, cytomegalovirus immune globulin intravenous (human), per vial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $3,630.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $3,090.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $2,290.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $2,570.40 / $5,011.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,041.74 / $2,041.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $2,187.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,041.74 / $2,041.74
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $1,819.70