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Montana rates for HCPCS Q5124

Injection Ranibizumab-Nuna Biosimilar (Byooviz) 0.1 Mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.79 / $67.36 / $305.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.68 / $97.68 / $97.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.80 / $61.80 / $97.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.68 / $97.68 / $97.68
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.80 / $67.05 / $204.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.80 / $61.80 / $61.80