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New York 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
$0.94 / $0.97 / $21.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.82 / $0.98 / $1.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.00 / $225.00 / $305.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.41
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.27 / $17.27 / $29.88
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.28 / $32.26 / $35.58
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $1.04 / $2.41