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South Dakota rates for HCPCS J7643

Glycopyrrolate, inhalation solution, compounded product, administered through DME, unit dose form, per mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.89 / $1.20 / $95.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $0.89 / $0.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $0.89 / $1.02