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Wisconsin rates for HCPCS J1364

Erythro Lactobionate /500 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.56 / $150.10 / $439.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.62 / $66.56 / $201.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.78 / $80.78 / $80.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.62 / $64.62 / $82.06
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.47 / $88.47 / $103.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.62 / $158.69 / $226.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.62 / $125.98 / $143.16
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.62 / $75.05 / $142.57
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.80 / $129.24 / $129.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.53 / $75.05 / $165.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.05 / $75.05 / $129.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $65.95 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.62 / $75.05 / $142.57
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.80 / $129.24 / $129.24
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.62 / $98.13 / $192.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$378.80 / $378.80 / $378.80
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.62 / $64.62 / $64.62
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.73 / $90.73 / $124.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.62 / $64.62 / $103.39