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Washington rates for HCPCS J2760

Phentolaine Mesylate Inj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$475.22 / $552.99 / $907.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $475.22 / $544.34
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$399.33 / $599.00 / $1,251.03
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $587.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.57 / $407.57 / $898.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $529.84
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.02 / $540.03 / $1,296.06
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$402.12 / $714.88 / $1,251.03
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.18 / $428.13 / $587.96
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$399.33 / $499.16 / $975.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $432.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $518.41