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South Dakota rates for HCPCS J7178

Injection Human Fibrinogen Concentrate Not Otherwise Specified 1 Mg (Desc Rvsd 1/1/19)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.52 / $1.52 / $1.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.52 / $1.52 / $1.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $1.52 / $1.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.53 / $2.17 / $4.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $1.52 / $1.67
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $1.82 / $2.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $1.78 / $3.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.66 / $1.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.52 / $1.52 / $1.52
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.52 / $1.52 / $1.52
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.52 / $1.52 / $1.52