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Wisconsin rates for HCPCS Q9955

Injection, perflexane lipid microspheres, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $12.02 / $28.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.88 / $15.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.80 / $128.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $19.95 / $47.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $15.14 / $17.38
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $12.88 / $16.22
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.88 / $3.24 / $4.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $12.88 / $23.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $16.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $54.95 / $70.79
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $13.18 / $64.57
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $15.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $16.60