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Maine rates for HCPCS J2760

Phentolaine Mesylate Inj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,002.29 / $1,002.29 / $1,080.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.30 / $528.17 / $528.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.07 / $524.77 / $1,369.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $432.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.02 / $432.02 / $432.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $432.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $523.17
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,002.29 / $1,002.29 / $1,080.05
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.30 / $528.17 / $1,080.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $756.04