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New Hampshire 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 / $1.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.01 / $1.01 / $1.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $1.04
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.73 / $3.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $2.50
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.34 / $1.71