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Montana rates for HCPCS J0741

Injection Cabotegravir And Rilpivirine 2mg/3mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.89 / $25.78 / $28.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.10 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.40 / $26.40 / $26.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.65 / $23.65 / $26.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.40 / $26.40 / $26.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.65 / $25.66 / $33.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.65 / $23.65 / $23.65