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New Hampshire 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
$0.76 / $0.76 / $0.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.73 / $3.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.36 / $0.36 / $0.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.89 / $0.89 / $2.14
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.91 / $1.34