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Montana rates for HCPCS J0841

Injection, crotalidae immune F(ab')2 (equine), 120 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $6,025.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $46,773.51 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $4,897.79 / $4,897.79
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,230.27 / $2,754.23
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,230.27 / $2,754.23
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $3,715.35
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,348.96 / $6,918.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $4,897.79