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Utah rates for HCPCS J7606

Formoterol fumarate, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose form, 20 mcg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $3.16 / $3.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.85 / $3.16 / $30.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.21 / $2.87 / $6.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.16 / $2.73 / $6.46
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.69 / $2.73
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.73 / $2.73 / $3.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.73 / $2.73 / $2.73