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Wisconsin rates for HCPCS J9040

Bleomycin Sulfate 15 Units (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.17 / $48.01 / $162.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.53 / $22.17 / $33.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.91 / $26.91 / $26.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.53 / $21.53 / $29.06
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.45 / $38.75 / $39.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.52 / $33.04 / $68.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.52 / $27.47 / $41.28
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.90 / $22.17 / $107.37
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $43.06 / $43.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.90 / $21.53 / $107.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.90 / $26.33 / $971.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.90 / $22.17 / $107.37
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $43.06 / $43.06
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.53 / $33.40 / $65.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.52 / $85.00 / $875.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.52 / $39.99 / $971.75
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.90 / $20.90 / $20.90
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $45.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.53 / $22.18 / $78.20