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Wisconsin rates for HCPCS J3105

Injection Terbutaline Sulfate Up To 1 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.82 / $8.22 / $61.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.39 / $7.61 / $7.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.24 / $9.24 / $9.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.39 / $7.39 / $9.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.11 / $10.11 / $11.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.05 / $5.59 / $7.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.47 / $12.14 / $13.80
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $2.74 / $16.39
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.87 / $14.78 / $14.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.85 / $2.74 / $37.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.74 / $2.74 / $14.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $2.74 / $16.39
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.87 / $14.78 / $14.78
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.41 / $7.39 / $7.95
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.39 / $7.39 / $7.39
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.18 / $10.38 / $10.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.39 / $7.39 / $11.82