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Montana rates for HCPCS J0285

Amphotericin B

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.29 / $41.29 / $102.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.89 / $55.89 / $115.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.41 / $43.41 / $55.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.89 / $55.89 / $115.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.41 / $47.09 / $61.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.41 / $43.41 / $43.41