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Wisconsin rates for HCPCS J2315

Injection, naltrexone, depot form, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.37 / $12.72 / $5,597.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $4.37 / $1,584.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.30 / $7.84 / $9.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $4.24 / $5.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.80 / $5.80 / $6.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.24 / $10.01 / $14.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $6.17 / $7.01
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.25 / $4.24 / $4.24
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.34 / $8.48 / $8.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.25 / $4.24 / $8.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $4.24 / $8.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.12 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.25 / $4.24 / $4.24
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.34 / $8.48 / $8.48
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $5.74 / $13.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.24 / $4.24 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $4.24 / $4.24
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.05 / $5.95 / $6.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.24 / $4.24 / $4.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $4.24 / $5.51