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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
$15.74 / $18.85 / $18.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.68 / $24.68 / $68.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $24.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.68 / $24.68 / $68.14
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $17.45 / $72.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07