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South Dakota rates for HCPCS Q5121

Injection, infliximab-axxq, biosimilar, (AVSOLA), 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.09 / $31.09 / $31.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.28 / $31.39 / $39.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.78 / $20.78 / $20.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.14 / $20.41 / $25.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.59 / $52.69 / $85.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.41 / $36.00 / $39.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.75 / $34.70 / $54.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.86 / $54.86 / $54.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.95 / $20.95 / $20.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.68 / $34.68 / $38.15
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.88 / $35.88 / $35.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.88 / $35.88 / $35.88