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Montana 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
$16.57 / $16.57 / $33.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $0.98 / $0.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.28 / $1.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $1.04