go back

Tennessee 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
$2.45 / $3.68 / $5.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.36 / $2.45 / $2.50
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.00 / $95.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $1.52 / $1.52