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Wisconsin rates for HCPCS J2250

Injection Midazolam Hydrochloride Per 1 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.28 / $29.76 / $96.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.27 / $1.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.19
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.21 / $0.21 / $0.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.27 / $0.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.22 / $0.25
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.16 / $0.71
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.30 / $0.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.09 / $16.27 / $38.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.16 / $0.16 / $0.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.16 / $0.71
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.30 / $0.30
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.24 / $1.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.15 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.15
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.16 / $0.21 / $0.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.23