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Wisconsin rates for HCPCS J9173

Inj., durvalumab, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.67 / $170.50 / $13,411.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.12 / $87.67 / $116.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.40 / $157.47 / $189.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.12 / $85.12 / $114.91
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.12 / $119.17 / $156.02
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.12 / $85.25 / $197.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.12 / $109.50 / $227.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.12 / $101.98 / $158.47
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.12 / $85.25 / $94.76
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.88 / $170.24 / $170.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.25 / $85.25 / $100.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.25 / $94.90 / $370.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.12 / $85.25 / $94.12
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.88 / $170.24 / $170.24
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.12 / $111.32 / $284.89
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.12 / $85.12 / $419.35
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.12 / $154.30 / $370.33
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.51 / $119.51 / $119.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.12 / $93.63 / $193.48