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South Dakota rates for HCPCS Q5122

Injection, pegfilgrastim-apgf (Nyvepria), biosimilar, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.16 / $131.16 / $131.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.16 / $133.36 / $165.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.61 / $133.61 / $133.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.76 / $136.76 / $170.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.76 / $223.15 / $392.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.11 / $146.99 / $146.99
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.44 / $175.52 / $308.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.38 / $161.10 / $308.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.28 / $146.28 / $146.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.01 / $131.16 / $146.01
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.04 / $132.04 / $132.04
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.04 / $132.04 / $132.04