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Wisconsin rates for HCPCS J2150

Injection, mannitol, 25% in 50 ml

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.50 / $6.40 / $9.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.36 / $4.05 / $4.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.24 / $2.24 / $4.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $3.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $65.00 / $85.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $4.70