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New Hampshire rates for HCPCS J7640

Formoterol, inhalation solution, compounded product, administered through DME, unit dose form, 12 mcg

Facilitymedian $3 · 10th–90th $3–$30%20%10th90th$3Professionalmedian $2 · 10th–90th $1–$30%20%10th90th$2$1.0$2.0$5.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.51 / $2.82 / $3.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.41 / $1.41 / $1.41
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.95 / $3.39 / $4.79
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.74 / $1.74 / $1.74
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.74 / $2.82 / $3.31
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.62 / $0.62 / $0.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $1.51 / $2.63
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.55 / $3.55 / $3.55