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Montana rates for HCPCS J9177

Injection, enfortumab vedotin-ejfv, 0.25 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $44.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $70.79 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $44.67 / $44.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $44.67
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $38.02 / $67.61
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $38.02 / $67.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $41.69 / $69.18
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $45.71 / $79.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $36.31