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Wisconsin rates for HCPCS J0179

Inj, brolucizumab-dbll, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.49 / $675.07 / $795.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.11 / $356.49 / $817.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.64 / $640.29 / $771.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.11 / $346.11 / $439.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$473.86 / $473.86 / $553.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.11 / $807.37 / $1,154.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.39 / $507.24 / $576.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.11 / $346.19 / $762.73
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.29 / $692.22 / $692.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.19 / $346.19 / $762.73
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.19 / $346.19 / $692.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $85.00 / $339.99
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.11 / $346.19 / $762.73
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.29 / $692.22 / $692.22
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.11 / $450.43 / $1,152.80
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,699.95 / $1,699.95 / $1,699.95
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.11 / $346.11 / $346.11
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.37 / $485.94 / $521.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.11 / $346.11 / $346.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.11 / $346.11 / $473.89