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South Dakota rates for HCPCS J1670

Injection, tetanus immune globulin, human, up to 250 units

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$593.00 / $593.00 / $593.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.00 / $598.91 / $698.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.61 / $593.00 / $733.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$677.95 / $825.18 / $1,581.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.76 / $577.04 / $634.76
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$506.45 / $692.46 / $1,001.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.99 / $652.16 / $858.10
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.95 / $648.95 / $648.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.05 / $593.00 / $652.29
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$577.04 / $577.04 / $577.04
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.04 / $577.04 / $577.04