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Montana rates for HCPCS J3315

Injection, triptorelin pamoate, 3.75 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.83 / $479.58 / $595.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,268.66 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$480.48 / $538.37 / $835.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.84 / $474.84 / $538.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$480.48 / $538.37 / $835.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.84 / $515.15 / $671.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.84 / $474.84 / $474.84