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Wisconsin rates for HCPCS J1571

Injection, hepatitis B immune globulin (Hepagam B), intramuscular, 0.5 ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $104.71 / $208.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $69.18 / $120.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $87.10 / $154.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $69.18 / $89.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $141.25 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $89.13 / $128.82
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $66.07 / $66.07
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $131.83 / $131.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $72.44 / $72.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $79.43 / $112.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $74.13 / $199.53
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $69.18 / $331.13
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $69.18 / $69.18
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $95.50 / $117.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $69.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $77.62 / $104.71