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Montana rates for HCPCS J0121

Injection, omadacycline, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $3.98 / $10.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.47 / $4.47 / $9.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.27 / $4.27 / $4.47
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.72 / $3.98 / $10.96
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.72 / $3.98 / $10.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.47 / $4.47 / $9.55
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $5.89 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $4.17 / $4.17