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West Virginia rates for HCPCS 80375

Drug/Substance Definitive Qual/Quant Nos 1-3

Insurance Carrier
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.57 / $19.18 / $37.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.17 / $50.00 / $59.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.95 / $29.94 / $115.39
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.02 / $312.02 / $312.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.27 / $12.36 / $36.17