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Wisconsin rates for HCPCS J2358

Olanzapine Long-Acting Inj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.00 / $5.69 / $6.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.92 / $3.00 / $7.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.65 / $5.40 / $6.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.92 / $2.92 / $3.70
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.00 / $4.00 / $4.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.92 / $7.06 / $10.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.96 / $4.55 / $5.18
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.65 / $2.92 / $6.41
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.38 / $5.84 / $5.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.65 / $2.92 / $6.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.92 / $2.92 / $5.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.92 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.65 / $2.92 / $6.41
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.38 / $5.84 / $5.84
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.92 / $4.51 / $9.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.92 / $2.92 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.92 / $2.92 / $2.92
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.65 / $4.09 / $4.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.92 / $2.92 / $4.00