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Montana rates for HCPCS J9017

Injection, arsenic trioxide, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.09 / $8.23 / $9.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.96 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.88 / $5.88 / $84.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.88 / $8.15 / $11.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.88 / $10.76 / $52.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.85 / $9.00 / $23.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.15 / $8.15 / $8.15