go back

Illinois 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 / $3.54 / $5.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.36 / $2.36 / $2.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $1.73 / $1.73
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.72 / $33.78 / $100.00
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $1.89 / $1.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.52 / $1.61