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Michigan rates for HCPCS J2670

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.30 / $3.30 / $10.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.30 / $3.30 / $3.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.44 / $3.44 / $3.51
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.30 / $5.78 / $10.30
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.30 / $3.37 / $4.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.13 / $4.13 / $4.38