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Montana rates for HCPCS J1110

Injection, dihydroergotamine mesylate, per 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.04 / $246.04 / $246.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.40 / $117.46 / $146.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.24 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.88 / $97.88 / $202.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $97.88
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.88 / $97.88 / $202.61
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.70 / $65.09 / $84.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00