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Montana rates for HCPCS J0256

Injection, alpha 1-proteinase inhibitor (human), not otherwise specified, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,613.63 / $4,613.63 / $4,613.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.95 / $6.28 / $11.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.19 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.89 / $5.89 / $12.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.46 / $5.46 / $5.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.89 / $5.89 / $12.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.46 / $5.92 / $7.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.46 / $5.46 / $5.46