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Wisconsin rates for HCPCS J3360

Injection, diazepam, up to 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $87.10 / $234.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $11.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.32 / $8.32 / $8.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $8.51
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.23 / $10.23 / $10.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $12.02 / $20.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $8.51 / $12.30
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $7.41 / $16.22
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $14.79 / $14.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $41.69 / $117.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $6.17 / $12.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $64.57 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $8.51 / $21.88
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $6.76 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.51 / $11.48 / $14.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $5.75 / $5.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $10.00