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Washington rates for HCPCS J7503

Tacrolimus, extended release, (Envarsus XR), oral, 0.25 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.86 / $2.25 / $3.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.86 / $2.29
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $95.00 / $95.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $552.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.73 / $3.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $2.25
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.69 / $1.85 / $4.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.64 / $1.87 / $4.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $70.00 / $80.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $2.08 / $5.49
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $1.70 / $1.91
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.91 / $1.99 / $3.48
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $1.83 / $3.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.83 / $1.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.25 / $4.25 / $4.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.85
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.83 / $1.83