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Montana rates for HCPCS J9309

Injection, polatuzumab vedotin-piiq, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $148.97 / $170.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.77 / $162.77 / $328.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $136.66 / $162.77
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.66 / $162.22 / $189.21
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $160.04 / $174.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $136.66 / $136.66