go back

Maine rates for HCPCS Q5104

Injection, infliximab-abda, biosimilar, (Renflexis), 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.07 / $62.64 / $67.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $28.08 / $31.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.13 / $32.79 / $85.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $27.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.00 / $27.00 / $27.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $27.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $32.70
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.64 / $62.64 / $67.50
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.26 / $29.53 / $39.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $47.25