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Wisconsin rates for HCPCS J1454

Injection, fosnetupitant 235 mg and palonosetron 0.25 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$592.77 / $1,212.70 / $1,392.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.50 / $592.77 / $734.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$719.38 / $1,064.68 / $1,283.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.50 / $575.50 / $776.92
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.74 / $920.80 / $1,054.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.50 / $1,359.25 / $2,357.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.50 / $683.50 / $1,230.26
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$486.53 / $592.77 / $633.04
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$909.53 / $1,151.00 / $1,151.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$486.53 / $606.35 / $668.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.35 / $674.99 / $2,905.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$486.53 / $592.77 / $633.04
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$909.53 / $1,151.00 / $1,151.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.50 / $874.64 / $2,238.50
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.50 / $708.35 / $3,478.85
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.50 / $1,210.66 / $2,905.58
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.90 / $808.00 / $808.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.50 / $592.82 / $684.85