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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
$31.09 / $31.09 / $31.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.81 / $31.39 / $39.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.36 / $20.36 / $20.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.20 / $19.98 / $20.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.58 / $52.69 / $141.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.98 / $41.31 / $45.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.32 / $20.21 / $47.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.21 / $47.21 / $65.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.46 / $20.46 / $20.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.09 / $40.09 / $44.10
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.50 / $40.50 / $40.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.50 / $40.50 / $40.50