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South Dakota rates for HCPCS J7203

Injection Factor IX, (antihemophilic factor, recombinant), glycoPEGylated, (Rebinyn), 1 IU

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.46 / $4.46 / $4.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.46 / $4.46 / $5.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.43 / $4.46 / $5.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.27 / $6.55 / $12.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.32 / $4.58 / $5.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $5.49 / $7.68
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.97 / $5.18 / $10.34
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.88 / $4.88 / $4.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.38 / $4.46 / $4.91
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.58 / $4.58 / $4.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.58 / $4.58 / $4.58