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Maryland rates for HCPCS J2760

Injection, phentolamine mesylate, up to 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $1,445.44 / $1,445.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $416.87 / $537.03
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $537.03
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $416.87 / $489.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $501.19
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11