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Wisconsin rates for HCPCS J1725

Hydroxyprogesterone Caproate

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.93 / $9.01 / $12.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.75 / $3.86 / $4.69
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $90.00 / $90.00