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Wisconsin rates for HCPCS P9057

Red Blood Cells Frozen/Deglycerolized/Washed Leukocytes Reduced Irradiated Each Unit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.96 / $540.96 / $540.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$540.96 / $540.96 / $876.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.64 / $329.95 / $650.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$920.40 / $920.40 / $920.40
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$542.08 / $542.08 / $876.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$542.08 / $542.08 / $876.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,274.40 / $1,274.40 / $1,274.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $1,357.58
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$542.08 / $542.08 / $813.12
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$920.40 / $1,274.40 / $1,274.40