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Montana rates for HCPCS J1645

Injection Dalteparin Sodium Per 2500 Iu (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.03 / $21.83 / $27.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.30 / $18.30 / $33.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.54 / $16.54 / $18.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.30 / $18.30 / $33.47
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.54 / $17.94 / $23.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.54 / $16.54 / $16.54