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Oklahoma rates for HCPCS 80375

Drug/Substance Definitive Qual/Quant Nos 1-3

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.66 / $23.95 / $29.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.56 / $112.04 / $112.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.60 / $10.16 / $15.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.60 / $10.16 / $14.51