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Montana rates for HCPCS Q5103

Injection, infliximab-dyyb, biosimilar, (Inflectra), 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,786.30 / $8,709.64 / $13,182.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $40.74 / $6,025.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $131.83 / $91,201.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $18.20 / $18.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $23.99 / $23.99
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $13.18 / $81.28
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $13.18 / $81.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $18.20 / $18.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $34.67 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81