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Missouri 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 / $2.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.36 / $2.36 / $2.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.53 / $1.56 / $2.04
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.36 / $2.94 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $1.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $1.75