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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
$44.60 / $44.60 / $44.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.97 / $45.03 / $56.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.45 / $45.45 / $45.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.88 / $44.60 / $51.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.31 / $58.00 / $111.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.11 / $40.56 / $44.62
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.31 / $48.68 / $66.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.89 / $44.42 / $56.63
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.00 / $48.80 / $48.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.90 / $44.60 / $49.06
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.56 / $40.56 / $40.56
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.56 / $40.56 / $40.56