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Texas 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
$0.67 / $3.56 / $59.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $1.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.74 / $1.69 / $3.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.74 / $0.74
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.00 / $95.00 / $95.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.89 / $1.58
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.76 / $0.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.36 / $0.36 / $0.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.89 / $0.89
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $1.03