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Montana rates for HCPCS J3415

Injection, pyridoxine HCl, 100 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.59 / $12.93 / $20.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.02 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.45 / $14.35 / $23.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.05 / $14.35
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.45 / $14.35 / $23.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.56 / $21.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.05 / $6.05