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Wisconsin rates for HCPCS J0470

Dimecaprol Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.34 / $114.49 / $119.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.34 / $51.34 / $91.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.55 / $56.42 / $56.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.55 / $144.75 / $206.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.55 / $88.85 / $100.96
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.01 / $59.81 / $59.81
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.70 / $18.70 / $89.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.01 / $59.81 / $59.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.42 / $56.42 / $77.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $85.00 / $131.62
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.01 / $59.81 / $59.81
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.70 / $18.70 / $89.72
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.53 / $90.53 / $90.53
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$299.05 / $299.05 / $299.05
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.55 / $54.55 / $54.55
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.03 / $83.97 / $86.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.42 / $56.42 / $78.98