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Idaho 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
$2.95 / $2.95 / $2.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.42 / $2.50 / $2.95
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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $3.21
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.42 / $2.42 / $2.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $78.00 / $1,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $1.52