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Vermont rates for HCPCS J7640

Formoterol, inhalation solution, compounded product, administered through DME, unit dose form, 12 mcg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.51 / $1.58