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South Dakota rates for HCPCS Q5115

Injection, rituximab-abbs, biosimilar, (Truxima), 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $13,182.57 / $16,982.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.90 / $4,073.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $38.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $52.48 / $102.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $47.86 / $47.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $37.15 / $37.15
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $28.18 / $28.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $33.88 / $47.86
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $29.51 / $29.51