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Rhode Island rates for HCPCS J0570

Buprenorphine Implant 74.2 Mg (Special Coverage Instructions Apply. See Mcm: 2049) (Reinstated 01/01/2017). Injection Penicillin G Benzathine Up To 1 200 000 Units (Special Coverage Instructions Apply. See Mcm: 2049) (Del 12/31/2010)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,826.25 / $4,826.25 / $4,826.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,188.00 / $1,232.55 / $1,262.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,262.25 / $1,311.75 / $1,386.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$935.55 / $1,336.50 / $1,336.50