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Montana rates for HCPCS J9266

Injection, pegaspargase, per single dose vial

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28,183.83 / $28,183.83 / $35,481.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,964.78 / $46,773.51 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33,113.11 / $33,113.11 / $57,543.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28,183.83 / $28,183.83 / $33,113.11
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,918.31 / $27,542.29 / $50,118.72
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,918.31 / $27,542.29 / $50,118.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $28,183.83 / $41,686.94
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $33,113.11 / $36,307.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28,183.83 / $28,183.83 / $28,183.83