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Wisconsin 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
$2.24 / $3.31 / $6.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $4.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.75 / $2.75 / $2.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $2.19 / $2.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.19 / $5.89 / $8.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $3.55 / $4.07
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.75 / $2.75 / $5.75
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.07 / $5.50 / $5.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.95 / $2.75 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $1.95 / $5.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.78 / $50.12 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $2.88 / $9.33
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.19 / $85.11 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $2.19 / $2.19
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.40 / $2.40 / $2.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.68 / $1.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $2.19 / $3.31