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Montana rates for HCPCS J1573

Injection, hepatitis B immune globulin (Hepagam B), intravenous, 0.5 ml

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.38 / $86.71 / $86.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.37 / $74.37 / $175.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $66.64 / $74.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.37 / $74.37 / $175.34
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $72.30 / $106.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $66.64 / $66.64