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Montana rates for HCPCS J1570

Injection, ganciclovir sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.64 / $43.10 / $47.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.57 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.30 / $36.63 / $36.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.63 / $39.54 / $39.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.30 / $36.63 / $36.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.54 / $42.90 / $55.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.54 / $39.54 / $39.54