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Wisconsin rates for HCPCS J7642

Glycopyrrolate Comp Con

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $0.95 / $2.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $0.98 / $1.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $1.04 / $1.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.48 / $2.70 / $3.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.15 / $1.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $1.01 / $2.82
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $1.60 / $1.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $1.04 / $95.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $1.04 / $1.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $90.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $1.01 / $2.82
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $1.60 / $1.60
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $95.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.37 / $14.55 / $22.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $1.66