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Wisconsin rates for HCPCS J9209

Mesna 200 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.91 / $2.66 / $3.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $1.91 / $2.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.33 / $2.33 / $2.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $1.86 / $2.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.98 / $3.35 / $3.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.86 / $2.81 / $5.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.47 / $1.86 / $2.69
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.91 / $4.54
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.72 / $5.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.37 / $4.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.48 / $179.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.91 / $5.09
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.72 / $5.61
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $2.14 / $5.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.86 / $1.86 / $979.65
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $5.09 / $179.29
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.35 / $2.61 / $3.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $1.86 / $2.35