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Alaska rates for HCPCS J7642

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.59 / $5.64 / $5.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $1.61 / $1.61
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.01 / $1.01 / $1.01
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.01 / $1.01 / $1.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.46 / $1.56 / $3.12