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Wisconsin rates for HCPCS J7643

Glycopyrrolate, inhalation solution, compounded product, administered through DME, unit dose form, per mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.26 / $89.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $1.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $2.29 / $3.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.26 / $1.45
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.89 / $2.82
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.58 / $1.58 / $1.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.78 / $2.82 / $95.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.89 / $1.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $54.95 / $89.13
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $64.57 / $100.00
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
$2.14 / $2.45 / $2.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.36 / $0.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.89 / $1.12