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Vermont rates for HCPCS J9210

Injection Emapalumab-Lzsg 1 Mg (Reinstated) Hexamethylmelamine (Deleted 3/31/2003)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.85 / $384.85 / $655.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$435.68 / $435.68 / $435.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.06 / $431.89 / $719.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.85 / $384.85 / $384.85
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.06 / $431.89 / $719.82
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.85 / $384.85 / $384.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.61 / $407.94 / $592.02