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North Carolina 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
$2.50 / $2.50 / $3.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.50 / $2.50
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 / $1.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $2.84
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.78 / $1.78 / $1.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $1.52
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.00 / $95.00 / $100.00