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Wisconsin rates for HCPCS J1455

Foscarnet Sodium Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.05 / $30.38 / $35.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.55 / $26.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.10 / $29.75 / $35.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $24.92
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.02 / $22.02 / $25.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.93 / $9.01 / $16.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.01 / $32.78 / $37.25
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.58 / $15.58 / $35.65
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.48 / $32.15 / $32.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.58 / $15.58 / $34.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.58 / $15.58 / $32.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.63 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.58 / $15.58 / $35.65
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.48 / $32.15 / $32.15
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $30.34 / $118.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$411.35 / $411.35 / $411.35
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.58 / $15.58 / $15.58
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.58 / $22.58 / $45.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $33.77