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Utah rates for HCPCS J7644

Ipratropium Bromide Inhalation Solution Administered Through Dme Unit Dose Form Per Milligram (Special Coverage Instructions Apply. See Mcm: 2100.5)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.45 / $0.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.42 / $0.49 / $0.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.36 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.39