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South Dakota rates for HCPCS J1558

Injection, immune globulin (xembify), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.85 / $14.85 / $14.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.85 / $18.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.11 / $15.11 / $15.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.55 / $14.84 / $18.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.11 / $22.55 / $40.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $16.70 / $16.70
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.11 / $17.89 / $24.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.59 / $17.14 / $38.34
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.23 / $16.23 / $16.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.85 / $16.63
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.91 / $14.91 / $14.91
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.91 / $14.91 / $14.91