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Montana rates for HCPCS J0850

Injection, cytomegalovirus immune globulin intravenous (human), per vial

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $5,011.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $4,365.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $2,089.30
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,905.46 / $5,128.61
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,905.46 / $5,128.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $4,365.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,819.70 / $2,570.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $1,819.70