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Wisconsin rates for HCPCS J7170

Injection Emicizumab-Kxwh 0.5 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.78 / $111.99 / $131.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $57.78 / $98.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.13 / $103.79 / $125.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $56.10 / $75.73
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.80 / $76.80 / $89.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.10 / $128.22 / $183.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.54 / $78.98 / $89.76
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.71 / $57.43 / $123.32
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.15 / $112.20 / $112.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.71 / $57.43 / $126.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.43 / $57.43 / $112.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.98 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.71 / $57.43 / $123.32
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.15 / $112.20 / $112.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $63.14 / $177.10
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.10 / $56.10 / $259.89
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $56.10 / $56.10
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.75 / $78.76 / $78.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.06 / $56.06 / $56.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $56.10 / $76.81