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Montana rates for HCPCS Q5104

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.26 / $2,943.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.95 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.79 / $31.79 / $31.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $31.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.79 / $31.79 / $31.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $29.29 / $38.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $27.00