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South Dakota rates for HCPCS J1575

Injection, immune globulin/hyaluronidase, 100 mg immuneglobulin

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.14 / $18.14 / $18.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.14 / $18.14 / $22.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.48 / $18.48 / $18.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.89 / $18.14 / $22.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.23 / $30.13 / $50.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.14 / $20.60 / $20.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.64 / $22.06 / $30.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.64 / $20.36 / $26.53
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.86 / $19.86 / $24.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.14 / $18.14 / $20.32
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.39 / $18.39 / $18.39
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.39 / $18.39 / $18.39