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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
$3.58 / $3.58 / $3.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.97 / $3.58 / $3.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.04 / $3.04 / $3.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.58 / $4.59 / $8.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.98 / $2.98 / $3.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.32 / $3.32 / $3.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.41 / $3.41 / $3.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.04 / $3.04 / $3.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.98 / $2.98 / $3.28
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.98 / $2.98 / $2.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.98 / $2.98 / $2.98