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Pennsylvania rates for HCPCS Q5103

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.39 / $852.43 / $6,418.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.09 / $1,002.00 / $7,200.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.10 / $21.29 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.36 / $20.36 / $21.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.64 / $19.98 / $19.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.98 / $19.98 / $19.98
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.62 / $20.62 / $134.88
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.49 / $852.43 / $9,096.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.08 / $59.83 / $7,200.00
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,375.33 / $1,659.47 / $4,495.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.64 / $19.98 / $19.98
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.98 / $19.98 / $19.98
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.80 / $24.80 / $28.78
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.80 / $24.80 / $28.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.09 / $40.09 / $73.36