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North Dakota rates for HCPCS J7640

Formoterol Inhalation Solution Compounded Product Administered Through Dme Unit Dose Form 12 Micrograms

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.36 / $2.36 / $5.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.36 / $2.45 / $2.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $1.52 / $1.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.36 / $2.54 / $95.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $1.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $1.67