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Wisconsin rates for HCPCS J7340

Carbidopa 5 Mg/Levodopa 20 Mg Enteral Suspension 100 Ml (Desc Revised 01/01/2017) Dermal And Epidermal (Substitute) Tissue Of Humanorigin With Or Without Bioengineered Or Processed Elements With Metabolically Active Elements Per Square Centimeter (Del 12/31/08)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$250.44 / $364.73 / $558.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.61 / $250.92 / $417.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.61 / $304.51 / $543.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.61 / $243.61 / $328.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$333.52 / $360.54 / $389.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.61 / $470.17 / $815.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.23 / $355.21 / $403.65
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.15 / $243.61 / $376.38
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.11 / $364.73 / $487.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.15 / $313.05 / $1,178.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.40 / $243.15 / $332.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $235.77
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.15 / $243.61 / $313.64
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.11 / $364.73 / $487.22
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.61 / $314.70 / $801.90
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.61 / $943.08 / $1,178.84
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.54 / $243.61 / $243.61
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.15 / $243.15 / $243.15
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.03 / $342.03 / $342.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.25 / $243.61 / $316.69