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Montana rates for HCPCS J9281

Mitomycin pyelocalyceal instillation, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.52 / $321.72 / $384.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$383.86 / $383.86 / $383.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.52 / $318.52 / $383.86
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.52 / $367.96 / $389.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.81 / $383.86 / $405.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.52 / $318.52 / $318.52