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Pennsylvania rates for HCPCS Q5104

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.00 / $62.12 / $7,854.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.27 / $2,808.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.44 / $28.75 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.50 / $27.50 / $28.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.65 / $27.00 / $27.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $27.00
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.38 / $32.38 / $80.31
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.30 / $62.12 / $5,852.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.30 / $29.53 / $2,265.94
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.65 / $27.00 / $27.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $27.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.47 / $45.47 / $52.76
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.47 / $45.47 / $52.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.05 / $25.05 / $25.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $46.53