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Montana rates for HCPCS J0695

Injection, ceftolozane 50 mg and tazobactam 25 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $20.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.12 / $9.12 / $19.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $8.91 / $9.12
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $7.76 / $22.39
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $7.76 / $22.39
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.12 / $9.12 / $19.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $12.59 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $8.91 / $8.91