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Montana rates for HCPCS J7196

Injection, antithrombin recombinant, 50 IU

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $138.04 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $144.54 / $144.54
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $107.15 / $125.89
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $107.15 / $125.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $79.43 / $144.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $141.25 / $141.25