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Massachusetts rates for HCPCS J7640

Formoterol Inhalation Solution Compounded Product Administered Through Dme Unit Dose Form 12 Micrograms

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $5.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.50 / $2.54
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.00 / $100.00 / $941.10
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $2.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.08 / $2.48 / $5.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $1.73 / $1.88
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.73 / $3.46
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.00 / $95.00 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $2.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $1.87