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Wisconsin rates for HCPCS J2997

Injection, alteplase recombinant, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $588.84 / $1,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $100.00 / $316.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $117.49 / $208.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $120.23
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $131.83 / $141.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $190.55 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $120.23 / $173.78
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $95.50 / $208.93
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $190.55 / $190.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $194.98 / $245.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $151.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $85.11 / $93.33
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $102.33 / $281.84
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $93.33 / $707.95
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $93.33
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $128.82 / $158.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $91.20 / $93.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $128.82