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Maryland rates for HCPCS J2760

Phentolaine Mesylate Inj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.51 / $1,460.45 / $1,460.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $558.73
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $436.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $550.22
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $491.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $457.94
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.63 / $394.63 / $394.63