go back

South Dakota rates for HCPCS J2760

Phentolaine Mesylate Inj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.02 / $432.02 / $432.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.76 / $436.33 / $544.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.76 / $457.76 / $572.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.60 / $624.21 / $1,196.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $436.51 / $480.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.34 / $539.16 / $690.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.59 / $454.34 / $591.94
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.78 / $472.78 / $472.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $475.22
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.51 / $436.51 / $436.51
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.51 / $436.51 / $436.51