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Wisconsin rates for HCPCS J2760

Phentolaine Mesylate Inj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.98 / $851.20 / $1,002.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $444.98 / $940.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.03 / $799.24 / $963.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $548.66
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$591.48 / $591.48 / $691.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.02 / $891.27 / $1,274.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $696.82 / $791.84
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.34 / $436.51 / $952.34
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.82 / $864.04 / $864.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.34 / $436.51 / $961.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.51 / $436.51 / $864.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $85.00 / $449.30
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.34 / $436.51 / $952.34
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.82 / $864.04 / $864.04
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $438.83 / $1,220.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.02 / $432.02 / $2,246.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $432.02
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.10 / $606.55 / $606.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.02 / $432.02 / $591.52