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Utah rates for HCPCS J2779

Injection, ranibizumab, via intravitreal implant (Susvimo), 0.1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $87.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $114.82 / $123.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $169.82 / $302.00
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $79.43 / $79.43
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $79.43 / $91.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86