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Wisconsin rates for HCPCS J0694

Injection Cefoxitin Sodium 1 Gm (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.29 / $49.26 / $114.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.93 / $19.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.98 / $5.98 / $5.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $6.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.54 / $6.54 / $7.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.78 / $10.90 / $15.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.09 / $7.92 / $9.00
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.31 / $5.13 / $10.69
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.88 / $9.56 / $9.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.13 / $11.40 / $71.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $5.13 / $9.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.31 / $5.13 / $10.69
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.88 / $9.56 / $9.56
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $7.16 / $14.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $4.78
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.42 / $6.71 / $9.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $10.03