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Wisconsin rates for HCPCS 80375

Drug/Substance Definitive Qual/Quant Nos 1-3

Insurance Carrier
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.64 / $8.64 / $93.08
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 / $64.30 / $73.06
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.51 / $14.51 / $29.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.51 / $14.51 / $112.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.13 / $19.34 / $49.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $65.00 / $3,000.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.51 / $14.51 / $29.32
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.32 / $57.08 / $80.05
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.88 / $50.00 / $112.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.97 / $14.36 / $49.06