go back

Utah rates for HCPCS Q5104

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.32 / $127.73 / $4,247.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.32 / $31.32 / $1,688.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.71 / $38.58 / $45.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $27.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.00 / $27.00 / $104.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $27.00