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Wisconsin rates for HCPCS J1457

Injection Gallium Nitrate 1 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.39 / $1.39 / $3.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.39 / $1.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $2.15 / $4.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.08 / $5.36 / $7.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.31 / $2.81
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.23 / $1.49 / $2.86
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.23 / $1.49 / $2.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.40 / $2.40 / $3.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.76 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.23 / $1.49 / $2.86
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.07
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.16 / $3.09 / $4.33
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.08 / $2.08 / $2.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.40 / $2.40 / $3.29