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Wisconsin rates for HCPCS J1729

Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $13.18 / $13.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $549.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $13.49 / $13.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $31.62 / $54.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $17.38 / $19.50
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $16.22 / $16.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $16.22 / $16.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $13.49 / $17.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $54.95 / $85.11
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $13.80 / $91.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $13.80 / $13.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.88 / $33.88 / $33.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $13.49 / $18.62