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Montana rates for HCPCS J7203

Injection Factor IX, (antihemophilic factor, recombinant), glycoPEGylated, (Rebinyn), 1 IU

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $5.54 / $10.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.94 / $4.94 / $11.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.46 / $4.46 / $4.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.94 / $4.94 / $11.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.46 / $4.84 / $6.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.46 / $4.46 / $4.46