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Wisconsin rates for HCPCS J7313

Injection Fluocinolone Acetonide Intravitreal Implant (Iluvien) 0.01 Mg (Desc Rvsd 10/1/19)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.73 / $970.71 / $1,143.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.14 / $513.08 / $1,286.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$622.67 / $921.54 / $1,110.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.14 / $498.14 / $632.63
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$682.00 / $682.00 / $797.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$498.14 / $1,202.56 / $1,718.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.03 / $765.68 / $870.09
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.76 / $497.80 / $1,097.77
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746.70 / $996.28 / $996.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.76 / $497.80 / $1,097.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.80 / $497.80 / $996.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $85.00 / $490.77
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.76 / $497.80 / $1,097.77
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746.70 / $996.28 / $996.28
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.14 / $760.69 / $1,526.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.35 / $2,454.35 / $2,454.35
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.14 / $498.14 / $498.14
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$613.33 / $699.39 / $776.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.14 / $498.14 / $747.21