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Wisconsin rates for HCPCS Q0138

Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-ESRD use)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $2,630.27 / $5,011.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $416.87 / $1,023.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $0.78 / $0.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.36 / $0.45
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.36 / $0.69 / $1.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.47 / $0.66
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $0.32 / $1.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.31 / $3.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.31 / $0.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.36 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.37 / $1.17
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.36 / $0.36 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.36 / $0.36
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.31 / $1.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.36 / $0.58