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Wisconsin rates for HCPCS J3095

Telavancin Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.33 / $14.57 / $17.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.33 / $13.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.89 / $13.15 / $15.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $9.02
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.74 / $9.74 / $11.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.11 / $15.46 / $22.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.24 / $11.00 / $12.50
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.97 / $7.47 / $15.67
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.21 / $14.22 / $14.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.97 / $7.47 / $16.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.47 / $7.47 / $14.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.09 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.97 / $7.47 / $15.67
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.21 / $14.22 / $14.22
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $9.51 / $23.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $7.11
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.94 / $9.98 / $10.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $10.67