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South Dakota rates for HCPCS J7196

Injection, antithrombin recombinant, 50 IU

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.60 / $168.60 / $168.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.94 / $168.60 / $168.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.31 / $143.31 / $143.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.60 / $227.00 / $415.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.50 / $140.50 / $154.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.75 / $168.75 / $168.75
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.31 / $143.31 / $143.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.50 / $140.50 / $154.55
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.50 / $140.50 / $140.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.50 / $140.50 / $140.50