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Wisconsin rates for HCPCS J2350

Injection, ocrelizumab, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.20 / $119.40 / $121,999.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.41 / $86.14 / $50,871.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.26 / $109.91 / $132.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.41 / $59.41 / $75.45
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.33 / $81.33 / $95.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.41 / $75.66 / $166.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.41 / $93.18 / $105.89
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.66 / $59.70 / $131.16
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.55 / $118.82 / $118.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.70 / $59.70 / $150.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.70 / $59.70 / $118.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.81 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.66 / $59.70 / $131.16
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.55 / $118.82 / $118.82
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.41 / $62.97 / $196.67
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.41 / $59.41 / $289.05
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.41 / $59.41 / $59.41
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.70 / $83.41 / $90.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.41 / $59.41 / $83.17