go back

Wisconsin rates for HCPCS J9355

Injection Trastuzumab Excludes Biosimilar 10 Mg (Desc Revised 7/1/2019)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.28 / $152.36 / $174.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.03 / $77.28 / $103.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.79 / $138.79 / $167.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.03 / $75.03 / $101.29
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.03 / $106.65 / $137.52
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.03 / $76.18 / $173.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.02 / $104.33 / $216.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.02 / $95.08 / $158.00
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.03 / $77.28 / $188.53
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.42 / $150.06 / $150.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.18 / $76.94 / $124.67
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.18 / $84.80 / $3,766.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.84 / $77.28 / $188.53
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.42 / $150.06 / $150.06
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.03 / $116.79 / $238.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.02 / $105.97 / $498.40
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.02 / $141.75 / $3,766.52
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.18 / $76.18 / $76.18
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.34 / $105.34 / $169.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.03 / $78.78 / $94.54