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Montana rates for HCPCS J9395

Injection, fulvestrant, 25 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $4,677.35 / $7,244.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.75 / $100.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $245.47 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.51 / $8.51 / $147.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $5.75 / $9.12
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.71 / $9.55 / $87.10
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.71 / $9.55 / $87.10
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $16.98 / $138.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $8.32 / $79.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $5.75 / $6.03