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Montana rates for HCPCS J1746

Injection Ibalizumab-Uiyk 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.39 / $96.06 / $166.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.83 / $87.83 / $177.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.26 / $79.26 / $87.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.83 / $87.83 / $177.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.26 / $85.99 / $112.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.26 / $79.26 / $79.26