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Montana rates for HCPCS J9325

Injection, talimogene laherparepvec, per 1 million plaque forming units

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $46,773.51 / $46,773.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $74.13 / $91.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $64,565.42 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $87.10 / $158.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $87.10
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $70.79 / $131.83
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $70.79 / $131.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $83.18 / $138.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $87.10 / $93.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13