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Michigan 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
$2.36 / $2.36 / $7.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.36 / $2.36 / $2.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.59 / $1.73 / $1.73
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.95 / $7.36
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.36 / $2.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $30.00 / $1,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.17 / $1.52 / $1.55