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Montana rates for HCPCS J1580

Injection, garamycin, gentamicin, up to 80 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.39 / $53.96 / $375.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $3.17 / $12.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.12 / $3.12 / $5.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.21 / $2.21 / $3.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.12 / $3.12 / $5.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.21 / $2.39 / $3.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.21 / $2.21 / $2.21