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Montana rates for HCPCS J2760

Phentolaine Mesylate Inj

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.33 / $470.90 / $940.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$583.91 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.88 / $512.88 / $1,107.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $512.88
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.88 / $512.88 / $1,107.35
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $468.71 / $611.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $432.02