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Wisconsin rates for HCPCS J1442

Injection Filgrastim (G-Csf) Excludes Bio- Similiars 1 Microgram (Revised 01/01/2016)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.01 / $1.93 / $2.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.03 / $2.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $1.85 / $2.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.48 / $1.83 / $1.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $2.41 / $3.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.01 / $1.53 / $1.74
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.99 / $0.99 / $2.13
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.49 / $2.00 / $2.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.99 / $0.99 / $2.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $1.10 / $2.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.99 / $0.99 / $2.13
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.49 / $2.00 / $2.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.52 / $3.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $85.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.40 / $1.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.11 / $1.40