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West 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
$0.89 / $0.89 / $7.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.76 / $0.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.40 / $44,999.55 / $69,999.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.76 / $70.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.89 / $0.89