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Kansas 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 / $17.67 / $21.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $0.95 / $1.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.48 / $5.27 / $6.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.43 / $4.43 / $4.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $1.01 / $1.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $1.04 / $1.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $1.04 / $1.77