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Montana rates for HCPCS J1364

Injection, erythromycin lactobionate, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $56.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $75,857.76 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $75.86 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $75.86
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.49 / $83.18 / $245.47
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $83.18 / $245.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $75.86 / $234.42
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $75.86 / $91.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $19.95