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Montana rates for HCPCS J2425

Injection Palifermin 50 Micrograms

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.75 / $43.45 / $59.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.30 / $16.30 / $67.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.30 / $35.54 / $35.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.30 / $16.30 / $67.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.54 / $38.57 / $50.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.54 / $35.54 / $35.54