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Michigan rates for HCPCS J2760

Injection, phentolamine mesylate, up to 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $831.76 / $1,348.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $436.52 / $588.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $933.25 / $1,862.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $389.05 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $1,096.48 / $1,348.96
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $446.68 / $588.84
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $436.52 / $446.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $446.68