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Montana rates for HCPCS J2515

Injection, pentobarbital sodium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $41.69 / $50.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $10.96 / $72.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $42.66 / $42.66
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $12.02 / $30.90
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.02 / $30.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $10.96 / $72.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $42.66 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $42.66 / $42.66