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Vermont rates for HCPCS 80375

Drug/Substance Definitive Qual/Quant Nos 1-3

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.45 / $91.45 / $91.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.21 / $96.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.95 / $23.95 / $29.94
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.21 / $96.40
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.26 / $23.95 / $29.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.25 / $14.78 / $34.40