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Indiana 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
$1.65 / $1.65 / $1.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.76 / $0.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.04 / $1.04 / $2.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $1.04 / $1.40
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.54 / $28,874.72 / $39,374.61
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34,124.66 / $34,124.66 / $34,124.66
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 / $2.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.89 / $0.89