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South Dakota rates for HCPCS Q5110

Injection, filgrastim-aafi, biosimilar, (Nivestym), 1 mcg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.49 / $0.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.32 / $0.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.44 / $0.51
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.42 / $1.36
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.27 / $0.27 / $0.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.33
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.28