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Oregon 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
$2.95 / $2.95 / $5.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.45 / $2.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.46 / $3.46 / $3.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $2.57 / $3.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $13,910.16 / $18,772.80
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.45 / $3.09 / $5.27
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.73 / $2,250,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.52 / $1.75