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Wisconsin rates for HCPCS J2503

Injection, pegaptanib sodium, 0.3 mg

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,051.17 / $1,922.99 / $2,725.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$824.26 / $1,170.86 / $1,330.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.42 / $785.50 / $1,071.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.25 / $889.25 / $1,178.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $65.00 / $85.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,966.62 / $4,966.62 / $4,966.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.25 / $889.25 / $1,217.56