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Montana rates for HCPCS J9301

Obinutuzumab Inj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,640.20 / $20,640.20 / $20,640.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.00 / $79.79 / $167.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.26 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.24 / $92.24 / $189.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.00 / $79.00 / $92.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.00 / $92.24 / $109.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.00 / $90.25 / $100.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.00 / $79.00 / $79.00