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South Carolina rates for HCPCS 80375

Drug/Substance Definitive Qual/Quant Nos 1-3

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.06 / $252.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.94 / $11.29 / $29.94
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.51 / $23.84 / $23.84
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.94 / $22.94 / $23.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.16 / $13.17 / $26.32