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Wisconsin rates for HCPCS J1570

Ganciclovir Sodium Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.72 / $77.26 / $91.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.64 / $39.54 / $68.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.43 / $49.43 / $49.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.54 / $39.54 / $50.21
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.13 / $54.13 / $63.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.54 / $88.37 / $126.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.68 / $70.06 / $79.61
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.54 / $39.61 / $86.97
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.46 / $79.08 / $79.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.61 / $39.61 / $86.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.61 / $39.61 / $79.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.09 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.54 / $39.61 / $86.97
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.46 / $79.08 / $79.08
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.54 / $45.49 / $101.07
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.54 / $39.54 / $360.55
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.54 / $39.54 / $39.54
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.61 / $39.61 / $39.61
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.51 / $55.51 / $88.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.54 / $39.54 / $59.31