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North Carolina 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
$1.01 / $1.01 / $1.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.01 / $1.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.41
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.01 / $1.01 / $1.13
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $1.04 / $1.35
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.00 / $100.00 / $100.00