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Montana rates for HCPCS J1448

Injection, trilaciclib, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.45 / $6.52 / $6.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.96 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.15 / $6.15 / $6.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.46 / $5.46 / $6.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.15 / $6.15 / $6.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.46 / $5.92 / $7.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.46 / $5.46 / $5.46