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Wisconsin rates for HCPCS J3350

Injection Urea Up To 40 Gm (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.09 / $71.09 / $158.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.09 / $71.09 / $88.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.99 / $75.55 / $75.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.55 / $172.45 / $246.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.38 / $74.55 / $90.47
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.09 / $71.09 / $71.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.09 / $71.09 / $71.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.88 / $88.88 / $115.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.09 / $71.09 / $71.09
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.55 / $75.55 / $75.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.88 / $88.88 / $121.69