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Arizona rates for HCPCS J0741

Injection, cabotegravir and rilpivirine, 2 mg/3 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.31 / $36.39 / $70.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.89 / $28.59 / $6,033.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.14 / $81.23 / $131.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.39 / $22.39 / $150.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.31 / $23.65 / $23.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.65 / $23.65 / $23.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.63 / $31.19 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.63 / $23.63 / $23.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.65 / $23.65 / $33.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.65 / $23.65 / $23.65