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Florida rates for HCPCS J7503

Tacrolimus Extended Release (Envarsus Xr) Oral 0.25 Mg (Reinstated 01/01/2016) Cyclosporine Parenteral 250 Mg/5 Ml (Del 12/31/99)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $3.39 / $6.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $2.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.83 / $3.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.97 / $1.93 / $1.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.70 / $3.24 / $40.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83