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New Hampshire rates for HCPCS J2760

Injection, phentolamine mesylate, up to 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $467.74 / $831.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $457.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $1,096.48 / $1,819.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $478.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $416.87 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $426.58 / $489.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $645.65