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Nebraska 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 / $5.67 / $6.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.36 / $2.36 / $3.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $1.73 / $1.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.36 / $2.94 / $95.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $1.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.87 / $0.90 / $2.22
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $2.22 / $2.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $1.52