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Wisconsin rates for HCPCS J7121

5% Dextrose In Lac Ringers

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.66 / $55.46 / $121.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.66 / $7.66 / $13.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.98 / $7.98 / $8.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.14 / $18.41 / $26.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.99 / $8.23 / $9.98
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.66 / $9.58 / $9.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.66 / $9.58 / $73.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.98 / $7.98 / $9.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.87 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.66 / $9.58 / $9.58
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.14 / $8.14 / $85.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.14 / $8.14 / $8.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.98 / $7.98 / $9.58