go back

South Carolina rates for HCPCS J7503

Tacrolimus Extended Release (Envarsus Xr) Oral 0.25 Mg (Reinstated 01/01/2016) Cyclosporine Parenteral 250 Mg/5 Ml (Del 12/31/99)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.92 / $1.92 / $7.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.62 / $1.83 / $1.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.85 / $1.58 / $2.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.92 / $2.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.95
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.11 / $1.83 / $2.82
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.11 / $227.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.90 / $2.08 / $4.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.56 / $1.83 / $1.90