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Montana rates for HCPCS Q5115

Injection, rituximab-abbs, biosimilar, (Truxima), 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,803.84 / $15,488.17 / $31,622.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $58.88 / $6,456.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $173.78 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $39.81
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $33.11 / $109.65
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $33.11 / $109.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $42.66 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $42.66 / $42.66