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New Hampshire 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 / $3.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.50 / $2.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.40 / $1.40
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $2.88 / $5.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.34 / $1.52 / $1.52
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.90 / $2.42