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South Dakota rates for HCPCS J1555

Injection, immune globulin (Cuvitru), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.84 / $16.84 / $16.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.84 / $16.84 / $21.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.18 / $17.18 / $17.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $16.98 / $21.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.93 / $27.74 / $48.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.84 / $19.70 / $19.70
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.93 / $21.11 / $29.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.80 / $20.02 / $36.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.43 / $18.43 / $18.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.61 / $16.84 / $18.86
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.59 / $17.59 / $17.59
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.59 / $17.59 / $17.59