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Maine 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
$2.76 / $2.76 / $2.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $0.98 / $1.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $198.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $1.26
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.76 / $2.76 / $2.98
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.01 / $2.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $1.04 / $1.82