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South Dakota rates for HCPCS J1556

Injection, immune globulin (Bivigam), 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.39 / $77.39 / $77.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.39 / $78.04 / $93.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.86 / $78.86 / $78.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.75 / $78.75 / $98.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.40 / $110.50 / $211.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.27 / $86.54 / $86.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.97 / $92.72 / $103.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.97 / $88.22 / $114.95
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.87 / $84.69 / $84.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.63 / $77.39 / $86.68
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.27 / $77.27 / $77.27
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.27 / $77.27 / $77.27