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South Dakota rates for HCPCS J7201

Injection Factor Ix Fc Fusion Protein (Recombinant) Alprolix 1 I.U. (Desc Revised 1/1/2017)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.59 / $3.59 / $3.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.59 / $3.59 / $4.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $3.60 / $4.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.29 / $5.19 / $9.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.55 / $3.63 / $3.99
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.58 / $4.29 / $6.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.58 / $4.12 / $5.36
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.32 / $3.93 / $3.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.58 / $3.59 / $3.95
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $3.63 / $3.63
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.63 / $3.63 / $3.63