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Maine rates for HCPCS Q5121

Injection Infliximab-Axxq Biosimilar (Avsola) 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.13 / $6,779.17 / $9,811.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.28 / $31.39 / $34.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.75 / $24.79 / $64.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.41 / $20.41 / $20.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.41 / $20.41 / $20.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.41 / $20.41 / $20.41
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.41 / $20.41 / $24.72
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.13 / $77.73 / $9,811.16
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.32 / $31.39 / $63.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.68 / $34.68 / $60.00