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Wisconsin rates for HCPCS 80336

Antidepressants Tricyclic Other Cyclicals 3-5

Insurance Carrier
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.06 / $8.06 / $13.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.27 / $61.08 / $93.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.95 / $29.94 / $139.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.86 / $16.86 / $16.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.86 / $16.86 / $16.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.15 / $85.00 / $3,000.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.86 / $16.86 / $16.86
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.58 / $63.58 / $63.58
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.00 / $50.00 / $50.00