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Montana rates for HCPCS J1260

Injection, dolasetron mesylate, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.84 / $5.84 / $5.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.78 / $5.78 / $12.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.78 / $6.17 / $6.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.78 / $5.78 / $12.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.86 / $5.78 / $6.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.20 / $12.20 / $12.20