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Montana rates for HCPCS J1457

Injection Gallium Nitrate 1 Mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.49 / $1.49 / $1.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $2.10 / $2.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.08 / $2.08 / $2.10
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $2.10 / $2.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.08 / $2.08 / $2.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.40 / $2.40 / $2.40