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South Dakota rates for HCPCS J7204

Injection Factor Viii Antihemophilic Factor (Recombinant) (Esperoct) Glycopegylated-Exei Per Iu

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.18 / $2.22 / $2.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.62 / $3.23 / $6.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.25 / $2.49
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.17 / $2.71 / $3.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.57 / $5.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.44 / $2.44 / $2.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.22 / $2.44
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.25 / $2.25 / $2.25
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.25 / $2.25