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Wisconsin rates for HCPCS J9395

Injection, fulvestrant, 25 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.93 / $13.96 / $16.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $6.93 / $54.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.41 / $12.45 / $15.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $6.73 / $9.08
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.73 / $9.76 / $12.33
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $6.98 / $15.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.73 / $10.19 / $20.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $8.77 / $16.59
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.73 / $6.98 / $146.61
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $13.46 / $57.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.98 / $7.19 / $106.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.98 / $7.77 / $2,103.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.73 / $6.98 / $146.61
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $13.46 / $57.18
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $10.48 / $23.85
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.73 / $85.00 / $274.26
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $52.74 / $2,103.23
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.44 / $9.44 / $154.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $6.86 / $8.48