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Wisconsin rates for RC 0252

Pharmacy - Non-Generic Drugs

Insurance Carrier
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.42 / $346.42 / $346.42
Molina
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,000.00 / $3,000.00 / $3,000.00