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Montana rates for HCPCS J0696

Injection, ceftriaxone sodium, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.88 / $41.11 / $301.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $1.80 / $4.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.20 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.56 / $1.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.43 / $0.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.56 / $1.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.47 / $0.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.43 / $0.43