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Wisconsin rates for HCPCS J2810

Injection, theophylline, per 40 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.63 / $0.84 / $0.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.67 / $1.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.40 / $0.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.89 / $1.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.52 / $0.59
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.42 / $0.42
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.42 / $0.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.42 / $0.42
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.63
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.52 / $0.52 / $0.52
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.59 / $0.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.37