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Montana rates for HCPCS J1743

Injection, idursulfase, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $562.34 / $1,513.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $758.58 / $91,201.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $616.60 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $562.34 / $616.60
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $575.44 / $1,659.59
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $575.44 / $1,659.59
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $616.60 / $1,621.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $562.34 / $794.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $562.34 / $562.34