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Connecticut 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
$1.01 / $1.52 / $3.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.82 / $0.98 / $1.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $1.04 / $202.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $1.04 / $3.00