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Montana rates for HCPCS Q9991

Injection, buprenorphine extended-release (Sublocade), less than or equal to 100 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,996.32 / $2,036.58 / $2,391.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,254.80 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,197.67 / $2,197.67 / $2,197.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,016.42 / $2,016.42 / $2,197.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,197.67 / $2,197.67 / $2,197.67
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,016.42 / $2,187.63 / $2,853.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,016.42 / $2,016.42 / $2,016.42