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Montana rates for HCPCS J1162

Injection, digoxin immune fab (ovine), per vial

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,633.37 / $6,011.98 / $10,407.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,671.68 / $5,671.68 / $11,717.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,168.22 / $5,168.22 / $5,671.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,671.68 / $5,671.68 / $11,717.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,168.22 / $5,607.04 / $7,313.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,168.22 / $5,168.22 / $5,168.22