go back

Maine 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
$6.84 / $6.84 / $7.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.50 / $2.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.73 / $2.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.73 / $2.10
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.84 / $6.84 / $7.38
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.50 / $3.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.52 / $2.20