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Wisconsin rates for HCPCS J7643

Glycopyrrolate Comp Unit

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.89 / $1.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $1.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $2.68 / $3.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $1.15 / $1.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.89 / $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
$0.78 / $95.00 / $95.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.89 / $1.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.89 / $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
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.12 / $2.49 / $3.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.36 / $0.45 / $0.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.89 / $1.12