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Montana rates for HCPCS Q5121

Injection, infliximab-axxq, biosimilar, (AVSOLA), 10 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $33.11 / $114.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $91.20 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $22.39 / $22.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $23.99 / $23.99
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $26.30 / $77.62
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $26.30 / $77.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $22.39 / $22.39
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $33.88 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $34.67 / $34.67