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Nebraska rates for HCPCS Q5104

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.00 / $51.90 / $59.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $154.59 / $4,984.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.93 / $30.57 / $41.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.94 / $29.03 / $30.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $28.39 / $35.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.05 / $47.60 / $222.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.05 / $25.05 / $27.85
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.40 / $51.98 / $71.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.06 / $39.39 / $109.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.65 / $27.00 / $29.70