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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
$19.05 / $19.50 / $19.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $19.50 / $53.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $20.42 / $20.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.65 / $79.43 / $117.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $37.15 / $41.69
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.50 / $23.99 / $23.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.50 / $23.99 / $23.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $19.50 / $29.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $54.95 / $85.11
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $85.11 / $85.11
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $35.48 / $44.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $13.80 / $13.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $19.50 / $26.92