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South Dakota rates for HCPCS J9210

Injection, emapalumab-lzsg, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$384.85 / $384.85 / $384.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.85 / $384.85 / $461.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.69 / $388.69 / $485.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$435.79 / $545.75 / $1,045.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.64 / $424.69 / $424.85
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$451.88 / $539.95 / $659.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.80 / $539.95 / $1,026.15
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.15 / $421.15 / $421.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.85 / $384.85 / $428.42
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$417.64 / $417.64 / $417.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.64 / $417.64 / $417.64