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Wisconsin rates for HCPCS J1562

Injection, immune globulin (Vivaglobin), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.74 / $9.74 / $21.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.63 / $9.74 / $10.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.51 / $15.05 / $32.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.85 / $18.02 / $25.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.73 / $15.57 / $17.69
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.63 / $10.40 / $14.40
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.08 / $5.08 / $5.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.63 / $10.40 / $14.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.40 / $16.13 / $17.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.21 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.63 / $10.40 / $14.40
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.08 / $5.08 / $5.08
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.12 / $21.60 / $30.29
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.40 / $16.13 / $18.14