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Wisconsin rates for HCPCS J2506

Injection Pegfilgrastim Excludes Biosimilar 0.5 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.60 / $134.13 / $18,823.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.34 / $92.02 / $7,914.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.68 / $165.28 / $199.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.34 / $89.34 / $113.46
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.22 / $163.75 / $163.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.67 / $89.34 / $113.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.97 / $87.57 / $99.51
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.40 / $58.40 / $196.75
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.60 / $178.68 / $178.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.40 / $58.40 / $851.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.40 / $65.01 / $178.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.98 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.40 / $58.40 / $196.75
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.60 / $178.68 / $178.68
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.97 / $89.34 / $360.05
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.34 / $89.34 / $641.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.34 / $89.34 / $89.34
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.43 / $125.43 / $270.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.34 / $99.45 / $134.01