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Montana rates for HCPCS J1301

Injection, edaravone, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.80 / $22.80 / $52.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.29 / $23.29 / $58.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.99 / $20.99 / $23.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.29 / $23.29 / $58.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.99 / $22.77 / $29.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.99 / $20.99 / $20.99