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Montana rates for HCPCS J0215

Injection, alefacept, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.15 / $29.15 / $39.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.01 / $41.01 / $90.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.01 / $41.64 / $41.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.01 / $41.01 / $90.07
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.01 / $41.64 / $41.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.14 / $47.14 / $47.14