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Vermont 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
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $3.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.06 / $2.06 / $2.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $2.04 / $3.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $3.41
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $2.04 / $3.41
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $3.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.83 / $4.24