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Indiana rates for HCPCS J2760

Injection, phentolamine mesylate, up to 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $891.25 / $1,905.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $436.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $630.96 / $933.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $812.83
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $645.65 / $870.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $891.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $524.81