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South Carolina rates for HCPCS Q2017

Injection Teniposide 50 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,456.01 / $2,456.01 / $9,929.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,396.11 / $2,485.96 / $2,545.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$310.76 / $606.53 / $3,144.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,852.11 / $3,084.99 / $3,825.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,545.87 / $2,545.87 / $2,545.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,545.87 / $2,545.87 / $2,545.87
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$279.39 / $346.27 / $3,182.34
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.39 / $279.39 / $4,629.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,456.01 / $2,456.01 / $2,824.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,121.56 / $2,645.71 / $2,895.30