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South Dakota rates for HCPCS J1568

Octagam Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.53 / $47.53 / $47.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $48.00 / $59.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.41 / $48.41 / $48.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $61.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.16 / $81.76 / $132.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $54.19 / $54.19
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.95 / $59.16 / $86.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.35 / $56.20 / $73.95
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.00 / $52.00 / $97.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $53.23 / $53.23
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.38 / $48.38 / $48.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.38 / $48.38 / $48.38