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Montana rates for HCPCS J0791

Injection, crizanlizumab-tmca, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.13 / $156.79 / $320.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.83 / $147.83 / $147.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.47 / $129.47 / $147.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.83 / $147.83 / $147.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.47 / $140.47 / $183.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.47 / $129.47 / $129.47