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South Dakota rates for HCPCS J1573

Injection, hepatitis B immune globulin (Hepagam B), intravenous, 0.5 ml

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 / $106.50 / $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
$78.18 / $86.00 / $115.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.21 / $78.18 / $107.71
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
$65.94 / $66.64 / $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