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South Carolina 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
$1,217.70 / $1,217.70 / $1,217.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,217.70 / $1,217.70 / $1,262.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,019.97 / $1,647.33 / $2,312.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,306.80 / $1,485.00 / $1,782.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,262.25 / $1,262.25 / $1,670.63
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,217.70 / $1,262.25 / $1,509.95
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.00 / $18.00 / $1,485.00