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Montana rates for HCPCS J2820

Injection, sargramostim (GM-CSF), 50 mcg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.86 / $55.95 / $126.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.34 / $68.34 / $141.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.37 / $50.37 / $68.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.34 / $68.34 / $141.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.37 / $54.64 / $72.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.37 / $50.37 / $56.07