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Pennsylvania rates for HCPCS Q5121

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.09 / $63.51 / $4,296.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.02 / $31.40 / $5,714.28
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.47 / $21.73 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.78 / $20.78 / $21.74
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.71 / $39.29 / $116.90
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.49 / $63.51 / $4,648.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.02 / $32.34 / $2,840.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.05 / $20.41 / $20.41
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.41 / $20.41 / $20.41
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.50 / $33.50 / $38.86
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.50 / $33.50 / $38.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.68 / $34.68 / $60.00