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Montana rates for HCPCS J2997

Injection, alteplase recombinant, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $1,148.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $102.33 / $446.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $213.80 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $104.71 / $257.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $104.71
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $93.33 / $269.15
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $93.33 / $269.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $104.71 / $257.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $95.50 / $131.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $93.33