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Wisconsin rates for HCPCS C9090

Injection, plasminogen, human-tvmh, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.80 / $28.80 / $28.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.80 / $28.80 / $36.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.00 / $159.00 / $159.00