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Vermont rates for HCPCS J1558

Injection, immune globulin (xembify), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.85 / $25.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.80 / $16.80 / $16.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.00 / $16.17 / $26.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.84 / $14.84 / $14.84
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.00 / $16.17 / $26.95
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.84 / $14.84 / $14.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.11 / $16.63 / $19.64