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South Carolina 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
$2.42 / $2.42 / $9.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.42 / $2.45 / $2.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $0.98 / $0.98
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.42 / $2.50 / $3.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.78 / $1.78 / $2.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $1.52