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Montana rates for HCPCS J2779

Injection Ranibizumab Via Intravitreal Implant (Susvimo) 0.1 Mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.04 / $87.69 / $94.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.02 / $91.02 / $91.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.93 / $78.93 / $91.02
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.02 / $91.02 / $91.02
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.93 / $85.64 / $111.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.93 / $78.93 / $78.93