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Washington rates for HCPCS J2760

Injection, phentolamine mesylate, up to 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $724.44 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $426.58 / $524.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $512.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $501.19 / $812.83
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $512.86 / $1,258.93
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $512.86 / $512.86
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $478.63 / $1,148.15
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $549.54