go back

Kentucky 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 / $5.01
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
$1.52 / $1.59 / $1.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.42 / $1.42
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.77 / $47,999.52 / $55,999.44
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,499.57 / $48,999.51 / $50,749.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.73 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $45.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $1.52