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New Hampshire rates for HCPCS Q5121

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $31.18 / $41.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.08 / $31.09 / $31.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.07 / $34.70 / $89.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.41 / $20.41 / $20.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.05 / $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
$21.41 / $33.15 / $63.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.68 / $34.68 / $34.68
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $70.18 / $3,000.00