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New York 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
$2.34 / $2.95 / $5.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.62 / $2.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $1.82 / $64.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $25.12 / $31.62
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50,118.72 / $53,703.18 / $75,857.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.15 / $1.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $1.51 / $1.82
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $1.74 / $1.74