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Montana rates for HCPCS J2540

Injection, penicillin G potassium, up to 600,000 units

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.40 / $59.40 / $59.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.89 / $2.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.20 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.88 / $0.88 / $3.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.88
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.88 / $0.88 / $3.27
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.86 / $1.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79