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South Dakota rates for HCPCS Q0139

Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for ESRD on dialysis)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.32 / $0.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.34 / $0.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.52 / $1.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.31 / $4,027.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.39 / $0.56 / $1.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.70 / $1.27
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.36 / $0.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.32 / $0.35
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.31 / $0.31
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.31 / $0.31