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Virginia 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
$2.50 / $5.01 / $35.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.42 / $2.50 / $2.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $1.37 / $1.37
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $27.00 / $27.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $2.94
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.78 / $2.50 / $2.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $1.52