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Wisconsin rates for HCPCS 96522

Refill&Maintenance Pump Drug Dlvr Systemic

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.58 / $139.41 / $205.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.69 / $212.60 / $466.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.97 / $279.33 / $434.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.51 / $216.66 / $779.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.13 / $139.30 / $208.47
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.00 / $275.30 / $394.78
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $582.54 / $779.72
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.83 / $440.64 / $440.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.63 / $188.00 / $407.79