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Montana rates for HCPCS J2507

Injection, pegloticase, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,660.82 / $3,697.44 / $7,338.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,692.76 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,069.85 / $4,069.85 / $8,054.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,660.83 / $3,660.83 / $4,069.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,069.85 / $4,069.85 / $8,054.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,660.83 / $3,971.66 / $5,180.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,660.83 / $3,660.83 / $3,660.83