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Wisconsin rates for HCPCS J1568

Octagam Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.95 / $94.34 / $111.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $49.45 / $6,061.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.41 / $87.91 / $105.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $47.53 / $60.36
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.08 / $65.08 / $76.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.52 / $60.51 / $136.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $70.15 / $79.70
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.46 / $48.38 / $48.72
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.78 / $95.06 / $95.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.24 / $48.38 / $48.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.38 / $54.19 / $95.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.06 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.46 / $48.38 / $48.72
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.78 / $95.06 / $95.06
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.52 / $50.38 / $164.25
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.30 / $240.30 / $240.30
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.52 / $47.52 / $47.52
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.38 / $48.38 / $48.38
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.34 / $66.73 / $69.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $53.23 / $99.81