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South Dakota rates for HCPCS Q5104

Injection, infliximab-abda, biosimilar, (Renflexis), 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.00 / $27.00 / $27.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.26 / $34.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.53 / $27.53 / $27.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.39 / $28.39 / $35.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.82 / $42.33 / $90.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.67 / $25.05 / $27.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.06 / $39.39 / $72.75
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.94 / $39.39 / $109.85
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.59 / $28.59 / $28.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $29.70
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.05 / $25.05 / $25.05
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.05 / $25.05 / $25.05