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Louisiana 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
$2.95 / $2.95 / $4.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.95 / $2.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.94 / $1.94 / $2.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.94 / $1.94 / $1.97
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $1.63