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South Dakota rates for HCPCS Q5101

Inj Filgrastim Gcsf Biosimil

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $0.46 / $0.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.46 / $0.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.42 / $0.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.53 / $0.63 / $1.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.41 / $0.46
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.40 / $0.44 / $0.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.44 / $0.88
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.44 / $0.44 / $0.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.46 / $0.51
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $0.37 / $0.37
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.37 / $0.37