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South Dakota rates for HCPCS J1746

Injection, ibalizumab-uiyk, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.26 / $79.26 / $79.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.26 / $79.26 / $96.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.73 / $80.73 / $80.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.41 / $79.26 / $98.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.47 / $113.53 / $217.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.95 / $79.39 / $87.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.34 / $95.26 / $134.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.60 / $92.34 / $167.17
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.73 / $86.73 / $86.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.26 / $79.26 / $87.19
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.39 / $79.39 / $79.39
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.39 / $79.39 / $79.39