go back

Montana rates for HCPCS J2406

Injection Oritavancin (Kimyrsa) 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.82 / $50.09 / $50.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.84 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.81 / $48.81 / $48.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.48 / $42.48 / $48.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.81 / $48.81 / $48.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.48 / $46.08 / $60.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.48 / $42.48 / $42.48