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South Carolina rates for HCPCS J7298

Levonorgestrel-Releasing Intrauterine Contraceptive System (Mirena) 52 Mg (Desc Revised 1/1/2017)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,506.14 / $3,659.84 / $4,533.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.63 / $1,214.63 / $1,561.67
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$927.00 / $927.00 / $927.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.16 / $1,093.17 / $2,039.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,282.65 / $1,457.56 / $1,749.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,238.93 / $1,238.93 / $1,238.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,238.93 / $1,238.93 / $1,238.93
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,214.63 / $1,457.56 / $1,639.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.70 / $1,248.37 / $1,668.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.63 / $1,214.63 / $1,230.00