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South Dakota rates for HCPCS Q5120

Injection, pegfilgrastim-bmez (ZIEXTENZO), biosimilar, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.32 / $7,080.44 / $10,562.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.62 / $38.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $30.90 / $30.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.16 / $30.32 / $31.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.03 / $47.30 / $392.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.79 / $30.32 / $31.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.65 / $43.24 / $444.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.17 / $37.07 / $777.68
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.35 / $27.35 / $27.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.32 / $30.32 / $33.75
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.99 / $27.99 / $27.99
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.99 / $27.99 / $27.99