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Montana rates for HCPCS J0743

Cilastatin Sodium Injection

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.43 / $8.43 / $16.57
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
$8.36 / $8.36 / $17.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.36 / $10.25 / $10.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.36 / $8.36 / $17.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.35 / $11.12 / $14.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25