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Washington rates for HCPCS J7642

Glycopyrrolate Comp Con

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.01 / $1.01 / $2.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $1.01 / $1.02
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.26 / $50.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $1.06 / $2.12
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $1.04
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $1.04