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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
$79.43 / $79.43 / $79.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $67.61 / $109.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $20.89 / $25.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $91.20 / $194.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $66.07 / $75.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $323.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $66.07 / $316.23
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $66.07 / $66.07