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Wisconsin rates for HCPCS J1562

Injection, immune globulin (Vivaglobin), 100 mg

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.77 / $18.20 / $26.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $10.00 / $18.20
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.71 / $10.47 / $14.45
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $5.13 / $5.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.71 / $10.47 / $14.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.45 / $16.22 / $17.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $64.57 / $85.11
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.12 / $9.12 / $9.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.45 / $16.22 / $18.20