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Wisconsin rates for HCPCS J1301

Injection, edaravone, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.39 / $36.74 / $43.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.99 / $21.62 / $52.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.24 / $38.83 / $46.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.99 / $20.99 / $26.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.74 / $28.74 / $33.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.99 / $26.73 / $61.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.99 / $34.03 / $38.68
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.84 / $18.84 / $46.33
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.26 / $41.98 / $41.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.84 / $18.84 / $41.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.84 / $18.84 / $39.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.41 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.84 / $18.84 / $46.33
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.26 / $41.98 / $41.98
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.99 / $28.80 / $73.70
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.05 / $102.05 / $102.05
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.99 / $20.99 / $20.99
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.47 / $29.47 / $29.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.99 / $20.99 / $28.74