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Montana rates for HCPCS J1562

Injection, immune globulin (Vivaglobin), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.46 / $10.46 / $11.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.72 / $14.72 / $14.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.72 / $14.72 / $14.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.72 / $14.72 / $14.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.72 / $14.72 / $14.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.40 / $14.40 / $14.40