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Montana rates for HCPCS J2670

Injection, tolazoline HCl, up to 25 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.43 / $3.43 / $3.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.44 / $3.44 / $3.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.44 / $3.44 / $3.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.13 / $4.13 / $4.13