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Virginia 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 / $1.64
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
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.72 / $0.72
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.00 / $48.00 / $48.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.78 / $0.89
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.76 / $1.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.36 / $0.36 / $0.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.57 / $0.89 / $0.89