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Wisconsin rates for HCPCS J3415

Injection, pyridoxine HCl, 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.23 / $25.60 / $36.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.29 / $20.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.56 / $7.56 / $7.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.05 / $9.36
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.27 / $8.27 / $9.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.05 / $42.80 / $61.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $23.11 / $26.26
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.05 / $12.80 / $13.55
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.67 / $12.10 / $19.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.27 / $12.80 / $77.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.10 / $12.80 / $19.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.57 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.05 / $12.80 / $13.55
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.67 / $12.10 / $19.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.04 / $11.40 / $49.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.05 / $6.05 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.05 / $6.05
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.49 / $8.49 / $16.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.05 / $9.68