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Connecticut rates for HCPCS J7503

Tacrolimus Extended Release (Envarsus Xr) Oral 0.25 Mg (Reinstated 01/01/2016) Cyclosporine Parenteral 250 Mg/5 Ml (Del 12/31/99)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.90 / $2.68 / $5.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $2.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.96 / $3.16 / $5.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.90 / $1.94 / $2.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $1.83 / $1.92