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Wisconsin rates for HCPCS J9340

Thiotepa 15 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$453.34 / $526.86 / $546.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.17 / $317.88 / $581.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.68 / $434.06 / $493.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,376.94 / $2,376.94 / $2,376.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.85 / $2,184.00 / $2,184.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.40 / $58.40 / $428.84
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,376.94 / $2,376.94 / $2,376.94
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.80 / $2,184.00 / $2,184.00