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Maryland 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
$2.51 / $2.51 / $2.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.51
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $22.91 / $26.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.62 / $0.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $1.51 / $1.58