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Montana rates for HCPCS J3241

Injection, teprotumumab-trbw, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $79,432.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $446.68 / $91,201.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $398.11
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $354.81 / $1,000.00
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $354.81 / $1,000.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $371.54 / $524.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $371.54