go back

Illinois 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
$0.95 / $1.43 / $2.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $0.95 / $1.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $1.12 / $2.92
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.14 / $41.84 / $54.02
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $2.86