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South Dakota rates for HCPCS J9301

Injection, obinutuzumab, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.00 / $20,640.20 / $20,640.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.00 / $79.00 / $94.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.61 / $79.00 / $95.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.45 / $132.60 / $156.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.45 / $87.34 / $6,210.38
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.18 / $97.28 / $123.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.03 / $93.70 / $117.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.44 / $86.44 / $91.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.00 / $79.00 / $95.04
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.86 / $85.86 / $85.86
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.86 / $85.86 / $85.86