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Wisconsin rates for HCPCS 80204

Drug Assay Methotrexate

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.28 / $53.22 / $333.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.38 / $36.26 / $46.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.93 / $100.28 / $106.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.43 / $15.43 / $157.34
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.22 / $38.57 / $97.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.33 / $124.26 / $190.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.19 / $103.86 / $118.03
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.05 / $20.05 / $46.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.05 / $30.86 / $183.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.37 / $38.57 / $81.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.29 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.05 / $20.05 / $46.28
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.22 / $91.78 / $130.90
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.14 / $77.14 / $183.21
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.13 / $20.21 / $20.21
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.57 / $38.57 / $82.14
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.57 / $202.49 / $210.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.29 / $30.86 / $81.00