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South Dakota rates for HCPCS J1645

Injection Dalteparin Sodium Per 2500 Iu (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.54 / $16.54 / $16.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.54 / $16.54 / $21.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.35 / $16.51 / $20.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.64 / $30.49 / $49.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.04 / $18.04 / $19.84
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.64 / $18.41 / $21.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.80 / $16.64 / $21.65
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.10 / $18.10 / $40.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.86 / $16.54 / $18.19
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.04 / $18.04 / $18.04
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.04 / $18.04 / $18.04