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South Dakota rates for HCPCS J3241

Injection, teprotumumab-trbw, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.19 / $359.19 / $359.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.19 / $362.68 / $434.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$365.96 / $365.96 / $365.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.21 / $359.21 / $449.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.52 / $513.50 / $983.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.56 / $359.09 / $395.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.52 / $430.91 / $607.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.57 / $423.08 / $824.45
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.08 / $393.08 / $393.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$347.10 / $359.19 / $395.11
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.09 / $359.09 / $359.09
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.09 / $359.09 / $359.09