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Montana rates for HCPCS J0694

Injection, cefoxitin sodium, 1 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.80 / $83.22 / $260.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.83 / $19.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.97 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.72 / $5.72 / $19.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $5.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.72 / $5.72 / $19.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $5.19 / $6.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $4.78