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Wisconsin rates for HCPCS J9050

Carmustine 100 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.61 / $347.28 / $398.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.46 / $245.61 / $298.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$298.08 / $441.15 / $531.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.46 / $238.46 / $321.92
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.54 / $429.23 / $437.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.46 / $442.83 / $920.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.25 / $238.46 / $533.01
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.64 / $245.61 / $3,724.01
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.96 / $476.92 / $476.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.64 / $178.85 / $3,724.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.64 / $193.30 / $16,586.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.64 / $245.61 / $3,724.01
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.96 / $476.92 / $476.92
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.46 / $315.60 / $895.99
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.46 / $765.00 / $10,081.35
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.46 / $2,016.27 / $16,586.83
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$334.80 / $334.80 / $6,409.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.46 / $252.77 / $301.69