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Pennsylvania 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 / $3.87 / $6.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.50 / $2.50
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.06 / $2.44 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.44 / $2.44 / $2.44
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
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $3.77 / $6.22
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.50 / $4.99
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $1.73 / $1.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $2.10