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Wisconsin rates for RC 0254

Pharmacy - Drugs Incident to Other Diagnostic Services

Insurance Carrier
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.95 / $1.95 / $1.95
Molina
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,000.00 / $3,000.00 / $3,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,976.00 / $4,976.00 / $4,976.00