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Montana rates for HCPCS J1956

Injection, levofloxacin, 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $9.94 / $126.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $2.37 / $2.77
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
$0.67 / $1.17 / $1.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.17 / $2.54 / $2.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $1.17 / $1.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $2.75 / $3.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $2.54 / $2.54