go back

Wisconsin rates for HCPCS J1322

Injection, elosulfase alfa, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.00 / $598.26 / $704.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.68 / $317.94 / $645.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$385.85 / $571.05 / $688.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.68 / $308.68 / $392.02
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$456.85 / $493.89 / $565.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.87 / $361.69 / $817.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.87 / $438.10 / $497.84
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.80 / $306.80 / $680.05
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.20 / $617.36 / $617.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.79 / $306.80 / $675.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.80 / $306.80 / $617.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $85.00 / $293.94
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.80 / $306.80 / $680.05
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.20 / $617.36 / $617.36
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.68 / $390.69 / $999.90
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,469.70 / $1,469.70 / $1,469.70
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.68 / $308.68 / $308.68
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.39 / $433.39 / $433.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.68 / $308.68 / $422.64