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Wisconsin rates for HCPCS C9254

Injection Lacosamide

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.19 / $84.35 / $398.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.20 / $0.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.20 / $0.20 / $0.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.20 / $0.20
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.49 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.19
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.20 / $0.20