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South Dakota rates for HCPCS J7503

Tacrolimus, extended release, (Envarsus XR), oral, 0.25 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $2.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.84 / $2.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $3.09 / $3.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.81 / $1.83 / $552.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.49 / $2.20 / $2.70
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.49 / $2.17 / $2.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $2.00
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83