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Wisconsin rates for HCPCS J0202

Lemtrada IV SOLN 12 MG/1.2ML

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,502.79 / $4,881.39 / $5,606.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,429.89 / $2,454.19 / $2,915.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,037.36 / $4,495.30 / $5,418.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,429.89 / $2,429.89 / $3,280.35
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,326.74 / $3,596.24 / $3,887.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,424.67 / $3,094.69 / $6,503.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,429.89 / $2,636.82 / $4,119.31
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,235.38 / $2,440.69 / $2,678.50
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,661.05 / $4,859.78 / $4,859.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,235.38 / $2,440.69 / $2,698.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,440.69 / $2,717.01 / $10,655.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,147.08 / $2,440.69 / $2,678.50
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,661.05 / $4,859.78 / $4,859.78
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,429.89 / $3,203.52 / $7,461.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,503.21 / $12,207.45 / $12,207.45
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,429.89 / $4,439.66 / $10,655.19
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,352.58 / $3,411.57 / $3,521.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,429.89 / $2,575.67 / $3,110.73