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New York 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 / $3.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.45 / $2.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.55 / $2.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.49 / $25.65 / $28.29
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.78 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $1.68
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73