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South Dakota rates for HCPCS Q0138

Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-ESRD use)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.44 / $0.52 / $1.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.31 / $0.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.37 / $0.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.36 / $0.50
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $0.32 / $0.32