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Vermont rates for HCPCS J2560

Injection Phenobarbital Sodium Up To 120 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$527.34 / $527.34 / $527.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $47.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.15 / $34.15 / $34.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.46 / $33.32 / $55.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $30.17
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.46 / $33.32 / $55.54
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $30.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.66 / $30.17 / $39.85