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Arizona rates for HCPCS 80375

Drug/Substance Definitive Qual/Quant Nos 1-3

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.86 / $34.86 / $57.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.18 / $13.35 / $19.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.06 / $1.54 / $2.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.61 / $23.95 / $29.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.34 / $112.04 / $112.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.05 / $10.37 / $19.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.05 / $10.16 / $15.55