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Montana rates for HCPCS J1742

Injection Ibutilide Fumarate 1 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.30 / $303.30 / $828.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$859.12 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.98 / $419.06 / $487.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.61 / $310.61 / $419.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.98 / $419.06 / $487.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.35 / $357.96 / $501.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.30 / $298.30 / $298.30