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Wisconsin rates for HCPCS J2357

Injection, omalizumab, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $67.61 / $7,244.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $79.43 / $8,511.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $56.23 / $102.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $45.71 / $57.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $63.10 / $66.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $51.29 / $107.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $57.54 / $83.18
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.38 / $44.67 / $44.67
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $89.13 / $89.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.38 / $40.74 / $40.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $40.74 / $64.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $50.12 / $144.54
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $45.71 / $223.87
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $45.71 / $45.71
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $56.23 / $69.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $45.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $45.71 / $61.66