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South Dakota rates for HCPCS J7190

Factor Viii (Antihemophilic Factor Human) Per I.U. (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.09 / $1.09 / $1.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.09 / $1.09 / $1.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.01 / $1.62 / $3.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $1.12 / $1.24
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.17 / $1.34 / $1.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.28 / $1.68
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.18 / $1.18 / $1.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.09 / $1.09 / $1.20
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.12
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.12