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Idaho 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
$1.19 / $1.19 / $1.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.01 / $1.19
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.01 / $1.01 / $1.29
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.97 / $0.97 / $1.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $78.00 / $1,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $1.46