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Wisconsin rates for HCPCS J1459

Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $97.72 / $13,182.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $51.29 / $4,365.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $63.10 / $112.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $50.12 / $64.57
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $75.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $58.88 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $64.57 / $93.33
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $51.29 / $51.29
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $102.33 / $102.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $50.12 / $50.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $56.23 / $102.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $50.12 / $151.36
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $50.12 / $251.19
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $50.12 / $50.12
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $67.61 / $81.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $48.98 / $50.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $56.23 / $75.86