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Wisconsin rates for HCPCS 80377

Drug/Substance Definitive Qual/Quant Nos 7/More

Insurance Carrier
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.17 / $3.17 / $93.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.82 / $23.17 / $35.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.09 / $52.88 / $73.06
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.55 / $17.55 / $29.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.61 / $17.55 / $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
$17.55 / $17.55 / $29.32
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.62 / $56.98 / $80.05
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.88 / $50.00 / $112.04
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.77 / $7.77 / $7.77
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.77 / $7.77 / $7.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.97 / $18.36 / $49.06