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Hawaii rates for HCPCS J7640

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $2.54 / $2.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.67 / $1.67 / $1.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.52 / $2.27
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60