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Montana rates for HCPCS J2315

Injection, naltrexone, depot form, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.28 / $4.70 / $1,572.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.66 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.69 / $4.69 / $9.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $4.24 / $4.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.69 / $4.69 / $9.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $4.59 / $6.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $4.24 / $4.24