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Montana rates for HCPCS J9313

Injection Moxetumomab Pasudotox-Tdfk 0.01 Mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.18 / $21.98 / $58.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.69 / $28.69 / $28.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.51 / $22.51 / $25.38
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.98 / $23.39 / $28.69
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.51 / $27.59 / $36.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.07 / $22.07 / $22.07