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South Carolina rates for HCPCS J1096

Dexamethasone Lacrimal Ophthalmic Insert 0.1 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.08 / $108.08 / $430.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.08 / $122.80 / $141.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.32 / $190.80 / $312.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.94 / $168.96 / $209.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.11 / $102.94 / $102.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.94 / $102.94 / $102.94
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.08 / $129.69 / $192.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.85 / $234.85 / $234.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.49 / $126.86 / $170.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.93 / $102.93 / $221.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.94 / $102.94 / $102.94