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Wisconsin rates for HCPCS J0841

Injection, crotalidae immune F(ab')2 (equine), 120 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $7,413.10 / $14,791.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $8,317.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $6,165.95 / $10,964.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $6,309.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $2,884.03 / $4,897.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,011.87 / $6,309.57 / $9,120.11
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $2,290.87
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,089.30 / $2,089.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $2,290.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,659.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $3,467.37 / $6,606.93
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $4,897.79 / $6,309.57
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $4,897.79
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $8,128.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $4,897.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $6,760.83