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South Carolina rates for HCPCS J1050

Injection Medroxyprogesterone Acetate 1 Mg (Reinstated) Injection Medroxyprogesterone Acetate 100 Mg Special Coverage Instructions Apply. See Mcm: 2049) (Old Description - Deleted 06/30/2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.75 / $238.39 / $519.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.53 / $0.54 / $1.47
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.60 / $55.60 / $55.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.97 / $0.97 / $0.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.65 / $0.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.26 / $0.53 / $0.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48