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South Dakota rates for HCPCS J2357

Injection, omalizumab, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $44.67 / $91.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $48.98 / $3,801.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $45.71 / $45.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $46.77 / $57.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $57.54 / $112.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $40.74 / $44.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $48.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $50.12 / $50.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $45.71 / $50.12
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $44.67 / $44.67