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Wisconsin rates for HCPCS J1050

Injection Medroxyprogesterone Acetate 1 Mg (Reinstated) Injection Medroxyprogesterone Acetate 100 Mg Special Coverage Instructions Apply. See Mcm: 2049) (Old Description - Deleted 06/30/2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $1.71 / $367.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $110.16 / $240.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.67 / $1.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.20 / $0.36 / $0.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.92 / $1.05
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $0.56 / $0.66
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $0.86 / $0.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.65 / $1.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $0.54 / $0.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $0.56 / $0.66
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $0.86 / $0.86
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $0.91 / $1.51
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.00 / $95.00 / $95.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.80 / $0.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.66