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Wisconsin rates for HCPCS Q5124

Injection Ranibizumab-Nuna Biosimilar (Byooviz) 0.1 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.65 / $63.65 / $142.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.79 / $63.65 / $235.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.33 / $132.87 / $137.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.80 / $61.80 / $83.43
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.61 / $84.61 / $98.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.80 / $414.67 / $592.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.19 / $292.44 / $332.31
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.80 / $62.15 / $136.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.15 / $62.15 / $136.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.15 / $62.15 / $93.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.57 / $208.79
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.80 / $62.15 / $136.16
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.60 / $188.12 / $575.29
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$747.02 / $747.02 / $747.02
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.80 / $61.80 / $61.80
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.77 / $86.77 / $86.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.80 / $61.80 / $98.88