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Vermont rates for HCPCS J7640

Formoterol Inhalation Solution Compounded Product Administered Through Dme Unit Dose Form 12 Micrograms

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.50 / $4.21
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
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.52 / $1.58