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Montana rates for HCPCS J2993

Injection, reteplase, 18.1 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $3,019.95 / $3,630.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $3,890.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $3,090.30 / $3,090.30
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $2,691.53
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $2,691.53
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $3,890.45
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,202.26 / $3,090.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,019.95 / $3,019.95