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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
$9.88 / $11.05 / $17.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.18 / $9.18 / $19.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.07 / $9.07 / $9.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.18 / $9.18 / $19.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.07 / $9.83 / $12.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.07 / $9.07 / $9.07