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Wisconsin rates for HCPCS J2507

Injection, pegloticase, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,748.03 / $7,277.72 / $65,513.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,660.82 / $3,770.66 / $31,896.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,576.04 / $6,772.54 / $8,163.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,660.83 / $3,660.83 / $4,649.25
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,012.01 / $5,012.01 / $5,857.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,660.83 / $4,660.25 / $9,687.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,632.59 / $5,257.47 / $5,974.40
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,169.69 / $3,638.86 / $8,067.88
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,458.29 / $7,321.66 / $7,321.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,169.69 / $3,638.86 / $8,019.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,638.86 / $3,638.86 / $7,321.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $85.00 / $3,565.32
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,169.69 / $3,638.86 / $8,067.88
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,458.29 / $7,321.66 / $7,321.66
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,660.83 / $3,660.84 / $11,859.59
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,660.83 / $3,660.83 / $17,826.59
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,660.83 / $3,660.83 / $3,660.83
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.31 / $5,139.81 / $5,139.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,660.83 / $3,660.83 / $4,759.08