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Montana rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $8.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $46,773.51 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.55 / $24.55 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $24.55
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.07 / $33.88 / $34.67
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.07 / $33.88 / $34.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.55 / $24.55 / $67.61
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.24 / $9.55 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76