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Wisconsin rates for HCPCS C9093

Injection, ranibizumab, via sustained release intravitreal implant (Susvimo), 0.1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.80 / $76.80 / $76.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.80 / $76.80 / $96.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$412.00 / $412.00 / $412.00