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Oklahoma rates for HCPCS J0207

Injection Amifostine 500 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,041.41 / $1,041.41 / $2,072.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.55 / $1,054.27 / $1,145.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,092.83 / $1,092.83 / $1,092.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,092.83 / $1,092.83 / $1,092.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$603.97 / $1,041.41 / $1,249.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,011.89 / $1,135.69 / $4,885.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.41 / $1,071.41 / $1,313.55