go back

South Dakota rates for HCPCS Q5125

Injection, filgrastim-ayow, biosimilar, (Releuko), 1 mcg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.69 / $1.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.46 / $0.46
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $0.68 / $0.92
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.52 / $0.92
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.42
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41