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South Dakota rates for HCPCS J1442

Injection, filgrastim (G-CSF), excludes biosimilars, 1 mcg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.01 / $1.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.01 / $1.01 / $1.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.08 / $1.67 / $2.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $1.09 / $1.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.18 / $1.21 / $1.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.18 / $1.20 / $1.48
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.09 / $1.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.12
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.99 / $0.99 / $0.99
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $0.99 / $0.99