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Montana rates for HCPCS J0202

Injection, alemtuzumab, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,429.89 / $2,648.58 / $3,037.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,786.99 / $2,786.99 / $5,869.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,429.89 / $2,429.89 / $2,786.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,429.89 / $2,786.99 / $3,376.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,429.89 / $2,805.24 / $3,067.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,429.89 / $2,429.89 / $2,429.89