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Vermont rates for HCPCS J1885

Injection Ketorolac Tromethamine Per 15 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.84 / $8.73 / $11.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.34 / $0.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.56 / $0.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.30
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.56 / $0.95
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.30 / $1.43