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Wisconsin rates for HCPCS J1428

Inj, eteplirsen, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.60 / $153.60 / $342.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.60 / $153.60 / $192.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.60 / $359.80 / $373.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $160.00 / $163.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.00 / $192.00 / $436.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.01 / $164.81 / $200.02
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.60 / $192.00 / $192.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.60 / $192.00 / $192.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $160.00 / $208.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $580.79
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.60 / $192.00 / $192.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$837.25 / $837.25 / $837.25
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.19 / $163.19 / $163.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $160.00 / $219.07