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Ohio 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 / $5.90 / $9.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.36 / $2.36 / $3.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.42 / $2.22
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.98 / $7.98 / $13.57
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.91 / $5.91 / $7.98
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 / $1.88
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.73 / $2.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.91 / $8.86 / $13.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $1.57