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Wisconsin rates for HCPCS J7677

Revefenacin inhalation solution, FDA-approved final product, noncompounded, administered through DME, 1 mcg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.19 / $0.28 / $0.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.28
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.26 / $0.28 / $0.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.19 / $0.45 / $0.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.30 / $0.34
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.28
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.38 / $0.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.19 / $0.21 / $85.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.17 / $0.19 / $0.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.28
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.38 / $0.38
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.30 / $1.10
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.31 / $85.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.31
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.19
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.27 / $0.27 / $0.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.28