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Wisconsin rates for HCPCS J0515

Injection Benztropine Mesylate Per 1 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.78 / $33.68 / $39.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.33 / $15.78 / $45.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.16 / $19.16 / $19.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.33 / $15.33 / $19.46
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.99 / $20.99 / $24.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.32 / $40.21 / $57.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.32 / $25.62 / $29.11
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.33 / $17.27 / $33.50
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.77 / $30.66 / $30.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.22 / $17.27 / $37.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.27 / $17.27 / $30.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.77 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.33 / $17.27 / $33.50
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.77 / $30.66 / $30.66
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.33 / $23.86 / $52.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.32 / $15.32 / $15.32
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.52 / $21.52 / $29.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.33 / $15.33 / $24.53