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Missouri 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 / $0.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $0.95 / $1.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $1.04 / $1.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $1.01 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $1.04 / $1.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $1.04 / $2.90