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Tennessee rates for HCPCS Q5104

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.05 / $36.82 / $53.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $30.31
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.41 / $222.75 / $222.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.85 / $27.85 / $33.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $55.08