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Wisconsin rates for HCPCS J7169

Injection, coagulation Factor Xa (recombinant), inactivated-zhzo (Andexxa), 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.00 / $120.00 / $267.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.00 / $120.00 / $150.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.05 / $282.47 / $292.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.00 / $125.00 / $127.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.80 / $132.06 / $188.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.50 / $127.50 / $127.50
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.00 / $150.00 / $150.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.00 / $131.56 / $150.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.00 / $125.00 / $162.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $1,054.95
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.00 / $150.00 / $150.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.50 / $127.50 / $1,457.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.50 / $127.50 / $127.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.00 / $125.00 / $171.15