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Rhode Island 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
$3.87 / $3.87 / $3.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $0.99 / $1.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $1.04 / $1.04