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South Carolina rates for HCPCS J7340

Carbidopa 5 Mg/Levodopa 20 Mg Enteral Suspension 100 Ml (Desc Revised 01/01/2017) Dermal And Epidermal (Substitute) Tissue Of Humanorigin With Or Without Bioengineered Or Processed Elements With Metabolically Active Elements Per Square Centimeter (Del 12/31/08)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.21 / $255.79 / $1,032.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.76 / $255.31 / $255.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.61 / $3.10 / $244.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.61 / $280.63 / $333.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.82 / $243.61 / $243.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.61 / $243.61 / $243.61
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.76 / $255.79 / $345.32
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.00 / $26.00 / $268.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.62 / $199.76 / $330.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.44 / $243.61 / $243.61