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Montana rates for HCPCS J0400

Injection, aripiprazole, intramuscular, 0.25 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.37 / $0.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.53 / $0.53 / $1.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.53 / $0.75 / $0.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.53 / $0.53 / $1.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.53 / $0.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $0.86 / $0.86