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Michigan rates for HCPCS J7643

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.89
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
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.80 / $0.89 / $0.89
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.89 / $1.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.24 / $30.00 / $1,500.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.36 / $0.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.89 / $0.91