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South Dakota rates for HCPCS J2506

Injection, pegfilgrastim, excludes biosimilar, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.34 / $89.34 / $89.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.66 / $90.23 / $112.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.01 / $91.01 / $91.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.36 / $20.57 / $25.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.98 / $98.70 / $641.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.24 / $65.01 / $89.34
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.98 / $29.97 / $221.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.00 / $70.08 / $221.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.78 / $97.78 / $97.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.34 / $89.34 / $99.45
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.40 / $58.40 / $58.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.40 / $58.40 / $58.40