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Montana rates for HCPCS Q5123

Injection, rituximab-arrx, biosimilar, (Riabni), 10 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.51 / $26.77 / $36.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.38 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.76 / $37.76 / $37.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.51 / $26.51 / $37.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.51 / $32.08 / $48.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.76 / $45.98 / $54.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.51 / $26.51 / $26.51