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South Dakota rates for HCPCS J7188

Injection Factor Viii (Antihemophilic Factor Recombinant) (Obizur) Per I.U. (Reinstated 01/01/2016) Injection Von Willebrand Factor Complex Human Iu (Del 12/31/06)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.23 / $3.23 / $3.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.23 / $3.23 / $3.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.30 / $3.30 / $4.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.54 / $5.46 / $8.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.23 / $3.23 / $3.55
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $3.87 / $5.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.68 / $3.87 / $8.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.53 / $3.53 / $3.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $3.23 / $3.55
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.23 / $3.23 / $3.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.23 / $3.23 / $3.23