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South Dakota rates for HCPCS J9309

Injection, polatuzumab vedotin-piiq, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.66 / $136.66 / $136.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $136.66 / $164.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.22 / $136.66 / $169.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.22 / $230.23 / $272.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.22 / $151.65 / $586.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.27 / $172.79 / $217.51
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.91 / $194.38 / $204.35
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.56 / $149.56 / $149.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $136.66 / $152.13
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.08 / $149.08 / $149.08
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.08 / $149.08 / $149.08