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Oklahoma rates for HCPCS J1620

Injection Gonadorelin Hydrochloride Per 100 Mcg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$172.21 / $172.21 / $342.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.21 / $172.21 / $172.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.09 / $180.82 / $212.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.30 / $180.30 / $180.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.30 / $180.30 / $180.30