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Wisconsin rates for HCPCS J1726

Injection, hydroxyprogesterone caproate, (Makena), 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.41 / $19.41 / $43.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.41 / $19.41 / $1,280.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.64 / $19.64 / $20.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.35 / $79.30 / $112.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.00 / $33.99 / $41.25
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.41 / $24.26 / $24.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.41 / $24.26 / $24.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.64 / $19.64 / $29.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.57 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.41 / $24.26 / $24.26
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.98 / $90.98 / $90.98
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.05 / $35.35 / $44.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.64 / $19.64 / $25.55