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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
$31.08 / $31.39 / $178.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.14 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.54 / $22.54 / $22.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.41 / $20.41 / $22.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.54 / $22.54 / $22.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.41 / $22.14 / $28.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.68 / $34.68 / $34.68