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Arizona 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
$3.16 / $5.90 / $8.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.39 / $2.45 / $2.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $95.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.52 / $1.52 / $1.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.52 / $1.52 / $1.52