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California 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
$2.45 / $5.52 / $6.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.36 / $2.45 / $2.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.72 / $1.84 / $2.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.73 / $2.71
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.88 / $2.88 / $4.88
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.81 / $2.81 / $4.25
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.93 / $638.07 / $801.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.00 / $95.00 / $100.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $2.50 / $2.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.73 / $2.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $1.52 / $1.88