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Montana rates for HCPCS J1428

Inj, eteplirsen, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.36 / $159.36 / $159.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.19 / $163.19 / $163.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.19 / $163.19 / $192.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $160.00 / $160.00