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South Dakota rates for HCPCS J7100

Infusion, dextran 40, 500 ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.87 / $79.87 / $79.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.29 / $79.87 / $79.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.63 / $25.78 / $25.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.69 / $91.38 / $196.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.94 / $66.56 / $75.69
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.83 / $97.42 / $143.68
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.38 / $97.42 / $195.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.90 / $67.90 / $67.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.56 / $66.56 / $66.56
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.56 / $66.56 / $66.56
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.56 / $66.56 / $66.56