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Wisconsin rates for HCPCS J0122

Inj., eravacycline, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $2.52 / $2.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.34 / $2.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.63 / $2.41 / $2.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.30 / $1.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.78 / $1.78 / $2.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $2.95 / $4.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $1.76 / $2.00
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.29 / $1.29 / $2.86
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.94 / $2.60 / $2.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.29 / $1.29 / $2.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.29 / $2.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.21 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.29 / $1.29 / $2.86
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.94 / $2.60 / $2.60
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.72 / $4.40
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.33 / $1.33
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.30 / $1.82