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Montana rates for HCPCS J1558

Injection, immune globulin (xembify), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $39.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $16.22 / $16.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $16.22
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $15.14 / $42.66
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $42.66
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $16.22 / $16.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $21.38 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $15.14