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Wisconsin rates for HCPCS G9017

Amantadine Hcl 100mg Oral

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.70 / $3.16 / $4.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.15 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $58.40
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $85.00 / $100.00