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Montana rates for HCPCS J3250

Injection, trimethobenzamide HCl, up to 200 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.51 / $62.68 / $71.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.12 / $57.12 / $108.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.29 / $57.51 / $58.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.70 / $57.12 / $69.59
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.19 / $61.48 / $64.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.51 / $57.51 / $57.51