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Oklahoma rates for HCPCS J1260

Injection Dolasetron Mesylate 10 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.70 / $5.70 / $11.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.70 / $5.70 / $5.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $6.17 / $6.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $6.17 / $6.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.63 / $6.09 / $13.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.20 / $12.20 / $13.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.98 / $12.20 / $13.58