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Montana rates for HCPCS J0257

Glassia Injection

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.15 / $6.91 / $12.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.72 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.22 / $6.22 / $14.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.64 / $6.22
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.22 / $6.22 / $14.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $6.12 / $7.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.64 / $5.64