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Montana rates for HCPCS J0713

Injection Ceftazidime Per 500 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,684.73 / $1,684.73 / $1,684.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.59 / $1.59 / $1.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $1.83 / $5.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.57 / $1.57 / $1.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $1.83 / $5.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.57 / $1.70 / $2.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.57 / $1.57 / $1.57