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Montana rates for HCPCS J2560

Injection Phenobarbital Sodium Up To 120 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.46 / $33.46 / $634.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.88 / $33.11 / $124.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.18 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.60 / $33.60 / $125.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $33.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.60 / $33.60 / $125.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $32.72 / $42.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $30.17