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South Carolina rates for HCPCS J1110

Injection Dihydroergotamine Mesylate Per 1 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.00 / $684.04 / $2,507.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.80 / $63.00 / $146.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.54 / $42.46 / $100.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $82.88 / $102.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.61 / $56.61 / $60.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.15 / $63.00 / $122.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00