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Montana rates for HCPCS J0291

Injection, plazomicin, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.82 / $4.32 / $8.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.09 / $4.09 / $9.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.50 / $3.50 / $4.09
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.09 / $4.09 / $9.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.50 / $3.81 / $4.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.50 / $3.50 / $3.50