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Vermont rates for HCPCS J0694

Injection Cefoxitin Sodium 1 Gm (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.44 / $46.44 / $46.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $8.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.80 / $1.80 / $5.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.51 / $5.67 / $9.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $4.78
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.51 / $5.67 / $9.44
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $4.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.54 / $4.78 / $9.24