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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
$14.79 / $21.88 / $489.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $426.58 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $602.56 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $794.33 / $1,737.80
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $269.15 / $478.63
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $436.52 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87