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Virginia rates for HCPCS Q5104

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.35 / $56.83 / $15,093.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $28.35 / $31.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.00 / $56.97 / $91.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $27.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.92 / $46.56 / $70.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.65 / $24.65 / $27.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $27.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $32.40 / $90.41
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.00 / $27.00 / $95.96
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.65 / $32.67 / $80.45
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.65 / $32.67 / $80.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.85 / $27.85 / $27.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.56 / $27.00 / $90.41