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Wisconsin rates for HCPCS J2779

Injection Ranibizumab Via Intravitreal Implant (Susvimo) 0.1 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.78 / $152.94 / $180.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.93 / $81.30 / $134.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.66 / $146.02 / $176.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.93 / $78.93 / $100.24
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.07 / $108.07 / $126.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.93 / $192.01 / $274.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.23 / $125.98 / $143.16
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.43 / $78.43 / $173.94
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.65 / $157.86 / $157.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.43 / $78.43 / $172.52
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.43 / $78.43 / $157.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.73 / $79.73 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.43 / $78.43 / $173.94
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.65 / $157.86 / $157.86
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.93 / $122.88 / $269.07
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.93 / $78.93 / $398.70
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.93 / $78.93 / $78.93
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.82 / $110.82 / $110.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.93 / $78.93 / $108.07