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Wisconsin rates for HCPCS J7121

5% Dextrose In Lactated Ringers Infusion, Up To 1000 Cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $107.15 / $134.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $12.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $15.85 / $27.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $8.91 / $10.23
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $9.55 / $9.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $9.55 / $74.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $9.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $54.95 / $85.11
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $8.13 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $8.13 / $8.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $6.03 / $6.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $10.96