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Montana rates for HCPCS J9019

Erwinaze Injection

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.96 / $401.47 / $1,119.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.49 / $711.15 / $1,248.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.15 / $411.15 / $463.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$401.47 / $427.27 / $857.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.15 / $463.54 / $503.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.08 / $403.08 / $403.08