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Ohio 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 / $2.20 / $3.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $0.95 / $1.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.09 / $1.71
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.40 / $1.40 / $2.38
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $1.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.10 / $1.12 / $1.43
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.53 / $0.53 / $0.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.56 / $2.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $1.04 / $1.46