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Montana rates for HCPCS J3410

Injection Hydroxyzine Hcl Up To 25 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.07 / $162.38 / $370.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $20.49 / $39.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.86 / $20.27 / $20.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.30 / $15.30 / $20.27
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.86 / $20.27 / $20.62
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.89 / $16.59 / $21.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.30 / $15.30 / $15.30