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Massachusetts 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 / $1.01 / $2.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.01 / $1.01 / $1.01
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.47 / $1.40 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $1.04 / $2.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.11 / $1.33 / $2.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.41
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $2.08
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.00 / $100.00 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $1.04 / $2.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $1.04 / $2.90