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Montana rates for HCPCS J1555

Injection, immune globulin (Cuvitru), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.36 / $21.28 / $36.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $19.05 / $41.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.84 / $16.84 / $19.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $19.05 / $41.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.84 / $18.27 / $23.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.84 / $16.84 / $16.84