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Nebraska rates for HCPCS Q5121

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.09 / $59.76 / $68.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.33 / $4,029.33 / $6,044.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.32 / $23.10 / $50.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.94 / $22.87 / $23.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.14 / $20.41 / $25.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $59.24 / $257.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.40 / $36.00 / $54.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.70 / $39.65 / $54.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.70 / $51.02 / $54.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.95 / $34.68 / $38.15