go back

Wisconsin rates for HCPCS J0200

Injection, alatrofloxacin mesylate, 100 mg

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $37.15 / $54.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $17.38 / $19.50
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $15.85
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $10.00 / $10.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $15.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $26.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $54.95 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $27.54