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Montana rates for HCPCS J2777

Injection Faricimab-Svoa 0.1 Mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $2,071.80 / $4,490.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.44 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.64 / $39.64 / $39.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $33.88 / $39.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.88 / $39.64 / $44.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.75 / $41.10 / $45.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $33.88 / $33.88