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Montana rates for HCPCS J3105

Injection Terbutaline Sulfate Up To 1 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.77 / $2.81 / $41.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.32 / $7.89 / $8.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.55 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.61 / $1.61 / $3.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $7.39 / $7.39
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.61 / $1.61 / $3.90
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.72 / $8.02 / $10.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.39 / $7.39 / $7.39