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Wisconsin rates for HCPCS J0121

Injection Omadacycline 1 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.13 / $7.82 / $9.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $4.13 / $8.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.03 / $7.44 / $8.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $4.01 / $5.09
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $5.50 / $6.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.09 / $9.19 / $13.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.05 / $5.71 / $6.49
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.01 / $4.01 / $8.56
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.02 / $8.03 / $8.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.01 / $4.01 / $8.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $4.01 / $8.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.87 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.01 / $4.01 / $8.56
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.02 / $8.03 / $8.03
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $5.16 / $13.20
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.09 / $4.09 / $4.09
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.64 / $5.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.01 / $4.01 / $4.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $4.01 / $5.73