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Indiana 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 / $2.36 / $10.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.36 / $2.36 / $2.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.35 / $1.35 / $2.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.35 / $1.82
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.77 / $28,874.72 / $39,374.61
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34,124.66 / $34,124.66 / $34,124.66
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 / $4.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.52 / $1.61