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Montana rates for HCPCS J0179

Inj, brolucizumab-dbll, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.11 / $349.56 / $817.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.10 / $388.10 / $934.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.11 / $346.11 / $388.10
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.10 / $388.10 / $934.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.11 / $375.50 / $489.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.11 / $346.11 / $346.11