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Wisconsin rates for HCPCS J0691

Injection, lefamulin, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.48 / $1.48 / $1.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.17 / $3.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.68 / $1.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $1.45 / $2.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.89 / $1.26
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.72 / $0.72
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.72 / $0.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.68 / $0.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.55 / $1.82 / $1.82
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $0.71 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.71 / $0.71
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $0.98 / $1.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.81 / $0.81 / $0.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.68 / $0.93