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South Dakota 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
$1.19 / $1.19 / $1.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $0.98 / $1.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.13 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.36 / $1.81 / $2.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $3.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.80 / $4.80 / $5.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $1.31