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Montana rates for HCPCS J1458

Injection, galsulfase, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.54 / $611.66 / $1,063.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$553.49 / $553.49 / $1,198.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $508.76 / $553.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$553.49 / $553.49 / $1,198.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $551.95 / $719.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $508.76 / $508.76