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California rates for HCPCS J7643

Glycopyrrolate, inhalation solution, compounded product, administered through DME, unit dose form, per mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.74 / $1.80 / $4.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.74 / $0.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.81 / $0.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.85 / $1.80
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.57 / $0.83 / $1.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $1.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.00 / $7.00 / $638.07
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.00 / $95.00 / $100.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.36 / $0.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.89 / $1.72