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Montana rates for HCPCS J1575

Injection, immune globulin/hyaluronidase, 100 mg immuneglobulin

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.78 / $22.25 / $37.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.05 / $20.05 / $41.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.14 / $18.14 / $20.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.05 / $20.05 / $41.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.14 / $19.69 / $25.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.14 / $18.14 / $18.14