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Montana rates for HCPCS J2504

Injection Pegademase Bovine 25 Iu

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.74 / $345.74 / $345.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$715.10 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.33 / $251.33 / $1,177.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.33 / $367.96 / $367.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.33 / $251.33 / $1,177.90
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.33 / $367.96 / $367.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.54 / $357.54 / $357.54