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Virginia rates for HCPCS J2760

Injection, phentolamine mesylate, up to 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $891.25 / $1,174.90
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
$416.87 / $831.76 / $1,445.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $707.95
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $676.08 / $1,023.29
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $416.87 / $549.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $41.69 / $41.69
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $416.87 / $676.08
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $512.86 / $616.60
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $512.86 / $616.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $436.52 / $741.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $416.87 / $524.81