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Pennsylvania 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 / $1.56 / $2.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.01 / $1.01
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.99 / $4.69 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.25 / $2.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.41
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.01 / $1.52 / $2.50
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.01 / $2.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.41
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.19 / $2.19 / $2.19
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $2.19 / $2.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $1.04 / $1.90