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Alaska rates for HCPCS J0470

Injection, dimercaprol, per 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.77 / $85.77 / $303.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.27 / $86.64 / $86.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.55 / $54.55 / $54.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.90 / $123.90 / $123.90
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.21 / $50.21 / $71.73
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.85 / $89.85 / $141.19
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.85 / $123.90 / $211.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.21 / $54.55 / $71.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.42 / $84.63 / $113.81