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Montana rates for HCPCS J9208

Ifosfamide 1 Gm (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.20 / $28.44 / $41.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.98 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.19 / $30.19 / $77.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.20 / $25.20 / $31.86
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.20 / $32.36 / $58.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.27 / $31.15 / $33.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.20 / $25.20 / $25.20