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Montana rates for HCPCS J7503

Tacrolimus, extended release, (Envarsus XR), oral, 0.25 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $2.00 / $2.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.02 / $2.02 / $4.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $2.02
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $2.02 / $2.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $2.10 / $2.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83