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South Carolina rates for HCPCS J2560

Injection Phenobarbital Sodium Up To 120 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.67 / $494.70 / $1,082.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.67 / $39.03 / $46.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.36 / $3.80 / $73.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $38.89 / $46.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.46 / $28.46 / $30.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $30.17
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.24 / $31.67 / $79.70
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.92 / $73.92 / $73.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $30.17