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South Dakota rates for HCPCS J7168

Prothrombin complex concentrate (human), Kcentra, per IU of Factor IX activity

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $4.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.55 / $4.57 / $8.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.51 / $2.95 / $2.95
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.95 / $2.95 / $3.31
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.95 / $2.95 / $2.95