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Utah rates for HCPCS J2760

Injection, phentolamine mesylate, up to 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.93 / $501.15 / $501.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.15 / $501.15 / $501.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$461.64 / $599.39 / $653.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $432.02
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.05 / $806.65 / $1,158.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.42 / $432.02 / $432.02