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Utah rates for HCPCS Q5124

Injection, ranibizumab-nuna, biosimilar, (Byooviz), 0.1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $69.18 / $69.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $69.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $199.53 / $257.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $831.76
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $74.13 / $74.13
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $61.66 / $72.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26