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Utah rates for HCPCS J7612

Levalbuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $2.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.45 / $2.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $2.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.35 / $33.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.44
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.32 / $0.33
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.27 / $0.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $0.14 / $0.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.38 / $0.38