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Alaska rates for HCPCS J7640

Formoterol, inhalation solution, compounded product, administered through DME, unit dose form, 12 mcg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $13.80 / $13.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $3.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.51 / $2.51 / $2.51
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.88 / $60.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.51 / $2.51 / $2.51
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $60.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.29 / $4.57