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Minnesota 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
$75.00 / $75.00 / $75.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.74 / $0.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.33 / $27.99 / $54.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.42 / $14.28 / $15.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.08 / $3.58 / $4.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.32 / $1.43
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.80 / $3.17 / $4.09
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.89 / $95.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.89 / $0.89 / $1.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.89 / $0.89 / $1.61