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South Dakota rates for HCPCS Q5123

Injection, rituximab-arrx, biosimilar, (Riabni), 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.51 / $26.51 / $26.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.51 / $26.76 / $36.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.00 / $27.00 / $27.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.71 / $34.04 / $42.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.92 / $50.56 / $81.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.92 / $33.31 / $253.17
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.70 / $50.95 / $72.48
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.90 / $39.70 / $70.73
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.16 / $24.16 / $24.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.51 / $26.51 / $32.46
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.92 / $29.92 / $29.92
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.92 / $29.92 / $29.92