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Missouri 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
$39.64 / $39.64 / $39.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.76 / $0.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.67 / $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 / $0.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $2.06 / $95.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.89 / $0.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.36 / $0.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.89 / $1.02