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Montana rates for HCPCS J1442

Injection Filgrastim (G-Csf) Excludes Bio- Similiars 1 Microgram (Revised 01/01/2016)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.01 / $1.01 / $1.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $1.13 / $2.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $1.13 / $2.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.08 / $1.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00