go back

South Dakota rates for HCPCS Q5113

Injection Trastuzumab-Pkrb Biosimilar (Herzuma) 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.37 / $69.37 / $69.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $69.37 / $93.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.11 / $83.11 / $83.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $75.30 / $94.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.48 / $130.96 / $212.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.48 / $86.26 / $317.82
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.99 / $93.57 / $125.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.71 / $88.69 / $107.97
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.90 / $73.90 / $73.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $69.37 / $82.55
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.48 / $77.48 / $77.48
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.48 / $77.48 / $77.48