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Montana rates for HCPCS J1554

Injection, immune globulin (Asceniv), 500 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.47 / $600.78 / $600.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$566.97 / $566.97 / $566.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$496.74 / $496.74 / $566.97
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$566.97 / $566.97 / $566.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$496.74 / $538.91 / $702.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$496.74 / $496.74 / $496.74