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Montana rates for HCPCS J0121

Injection Omadacycline 1 Mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.05 / $4.38 / $8.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.42 / $4.42 / $9.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.09 / $4.09 / $4.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.42 / $4.42 / $9.49
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.09 / $4.36 / $5.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $4.01 / $4.01