go back

Minnesota 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
$1.19 / $1.19 / $1.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $0.99 / $1.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.33 / $21.42 / $54.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.42 / $14.28 / $15.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.08 / $3.58 / $4.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.32 / $1.43
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.80 / $3.17 / $4.09
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.53 / $1.01 / $4.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $2.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $1.93