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South Dakota rates for HCPCS J1571

Hepagam B Im Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.64 / $66.64 / $66.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $66.64 / $86.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.38 / $66.64 / $82.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.02 / $102.47 / $196.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $80.26 / $80.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.23 / $86.00 / $115.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.96 / $77.53 / $106.67
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.93 / $72.93 / $72.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $74.64 / $74.64
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.66 / $71.66 / $71.66
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.66 / $71.66 / $71.66