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Wisconsin rates for HCPCS C9472

Injection, talimogene laherparepvec, 1 million plaque forming units -PFU

Insurance Carrier
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $234.42 / $234.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $66.07 / $66.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $58.88 / $58.88
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $186.21 / $234.42
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $66.07 / $66.07