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West Virginia rates for HCPCS J0470

Injection, dimercaprol, per 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.55 / $54.55 / $64.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.27 / $54.55 / $54.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.73 / $44,999.55 / $69,999.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.55 / $54.55 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.55 / $54.55 / $81.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.73 / $56.42 / $64.18