go back

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
$75.86 / $77.62 / $213.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $91.20 / $91.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $91.20
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $87.10 / $245.47
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $87.10 / $245.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $91.20 / $91.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $83.18 / $107.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86