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Montana rates for HCPCS J3095

Telavancin Injection

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.75 / $9.03 / $13.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.09 / $8.09 / $16.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $8.09
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.09 / $8.09 / $16.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.72 / $10.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $7.11