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Oklahoma 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 / $1.98 / $3.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.87 / $2.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.24 / $1.95 / $3.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.98 / $2.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.72 / $1.83 / $2.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.76 / $1.83 / $1.94