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South Dakota rates for HCPCS J1566

Injection Immune Globulin Intravenous Lyophilized (E.G. Powder) 500 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.80 / $78.80 / $78.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.80 / $82.52 / $98.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.29 / $80.29 / $80.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.54 / $82.54 / $103.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.74 / $116.83 / $223.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.80 / $91.50 / $91.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.53 / $98.04 / $142.50
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.21 / $92.83 / $122.15
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.22 / $86.22 / $86.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.98 / $78.80 / $88.26
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.70 / $81.70 / $81.70
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.70 / $81.70 / $81.70