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Kansas 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
$13.20 / $13.20 / $58.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.74 / $0.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.53 / $1.80 / $2.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.51
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 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.76 / $95.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.89 / $0.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.36 / $0.84 / $0.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.89 / $0.89