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Tennessee rates for HCPCS J0850

Injection Cytomegalovirus Immune Globulin Intravenous (Human) Per Vial (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,808.65 / $2,352.27 / $3,845.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,808.65 / $1,808.65 / $2,189.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,108.21 / $2,108.21 / $2,108.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,808.65 / $1,808.65 / $1,808.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,808.65 / $1,808.65 / $1,808.65
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,405.84 / $9,043.25 / $9,060.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,808.65 / $1,808.65 / $2,025.69