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New York 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
$0.71 / $0.71 / $1.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $0.76 / $0.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.85 / $1.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.80 / $15.80 / $27.33
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.10 / $45.75 / $50.45
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.78 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.89 / $1.09
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76