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Montana rates for HCPCS J9325

Injection Talimogene Laherparepvec Per 1 Millionplaque Forming Units

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,450.00 / $46,450.00 / $46,450.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.94 / $80.59 / $92.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.31 / $86.31 / $158.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.94 / $73.94 / $86.31
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.94 / $86.31 / $97.60
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.94 / $85.14 / $94.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.94 / $73.94 / $73.94