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Montana rates for HCPCS J7170

Injection, emicizumab-kxwh, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.01 / $69.48 / $69.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.34 / $59.34 / $141.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $56.10 / $59.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.34 / $59.34 / $141.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $60.87 / $79.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $56.10 / $56.10