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Michigan 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 / $0.95 / $2.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $0.95 / $1.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.10 / $1.10 / $1.41
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $1.19 / $2.96
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $1.02 / $1.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.24 / $30.00 / $1,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $1.04 / $1.13