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South Dakota rates for HCPCS Q5103

Injection, infliximab-dyyb, biosimilar, (Inflectra), 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.36 / $32.36 / $48.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $1,621.81 / $6,456.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $20.42 / $20.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $24.55 / $30.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $52.48 / $141.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $41.69 / $41.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $25.12 / $25.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $39.81 / $43.65
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $40.74 / $40.74