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South Dakota rates for HCPCS J1459

Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.74 / $50.74 / $50.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.18 / $50.94 / $63.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.71 / $51.71 / $51.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.10 / $50.74 / $62.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.14 / $82.38 / $138.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.43 / $56.48 / $56.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.32 / $60.52 / $86.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.49 / $56.74 / $73.93
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.53 / $55.53 / $97.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.28 / $50.74 / $56.83
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.43 / $50.43 / $50.43
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.43 / $50.43 / $50.43