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South Dakota rates for HCPCS J7177

Injection, human fibrinogen concentrate (Fibryga), 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.23 / $1.23 / $1.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.23 / $1.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.23 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.73 / $3.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.10 / $1.21 / $1.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.11 / $1.45 / $1.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.45 / $2.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.35 / $1.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.23 / $1.35
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.21 / $1.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.21 / $1.21 / $1.21