go back

South Dakota rates for HCPCS J7170

Injection, emicizumab-kxwh, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.10 / $56.10 / $56.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $56.10 / $69.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.95 / $56.10 / $66.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.42 / $82.12 / $157.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.98 / $57.43 / $63.17
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.82 / $68.92 / $91.04
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.70 / $62.38 / $124.63
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.40 / $61.40 / $61.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $56.10 / $61.71
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.43 / $57.43 / $57.43
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.43 / $57.43 / $57.43