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Wisconsin rates for HCPCS G2069

Medication assisted treatment, buprenorphine (injectable) administered on a monthly basis; bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled opioid treatment program)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,819.70 / $2,089.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $1,737.80 / $2,454.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,495.41 / $7,244.36 / $10,715.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,951.21 / $4,073.80
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,995.26 / $2,630.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,995.26 / $2,818.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $60.26 / $87.10
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,041.74 / $2,041.74
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $3,162.28