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Montana rates for HCPCS J7201

Injection, Factor IX, Fc fusion protein, (recombinant), Alprolix, 1 IU

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.02 / $9.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.07 / $4.07 / $9.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.63 / $3.63 / $4.07
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.47 / $3.72 / $10.47
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $3.72 / $10.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.07 / $4.07 / $9.55
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.55 / $5.13 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.63 / $3.63 / $3.63