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South Dakota rates for HCPCS J9266

Injection, pegaspargase, per single dose vial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28,424.06 / $28,424.06 / $28,424.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28,424.06 / $28,424.06 / $34,393.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27,581.29 / $28,424.06 / $34,476.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,249.06 / $32,484.64 / $56,848.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28,424.06 / $31,641.95 / $119,518.82
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,846.00 / $35,191.69 / $45,117.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,216.85 / $32,484.64 / $42,636.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31,105.57 / $31,105.57 / $31,105.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28,424.06 / $28,424.06 / $33,824.62
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31,105.57 / $31,105.57 / $31,105.57
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31,105.57 / $31,105.57 / $31,105.57