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South Dakota rates for HCPCS J2792

Injection Rho D Immune Globulin Intravenous Human Solvent Detergent 100 Iu (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.46 / $25.46 / $25.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.46 / $25.46 / $37.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $33.11 / $41.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.08 / $44.00 / $84.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.15 / $34.46 / $36.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.63 / $39.44 / $57.51
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.76 / $37.46 / $49.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.86 / $27.86 / $27.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.46 / $28.52 / $28.52
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.77 / $30.77 / $30.77
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.77 / $30.77 / $30.77