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South Dakota rates for HCPCS J9021

Injection Asparaginase Recombinant (Rylaze) 0.1 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.47 / $55.47 / $55.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.47 / $55.47 / $66.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.39 / $55.47 / $69.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.30 / $93.46 / $110.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.30 / $61.56 / $239.05
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.25 / $81.20 / $104.85
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.28 / $81.56 / $104.85
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.70 / $60.70 / $60.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.47 / $55.47 / $66.01
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.52 / $60.52 / $60.52
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.52 / $60.52 / $60.52