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Pennsylvania 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
$1.22 / $1.22 / $1.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.76 / $0.76
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$639.35 / $752.18 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.18 / $752.18 / $752.18
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
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.22 / $1.22 / $1.22
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.76 / $0.76
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $1.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.36 / $0.36 / $0.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.89 / $1.15