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Wisconsin 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
$2.36 / $2.36 / $5.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.36 / $2.45 / $2.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.73 / $1.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $3.57 / $5.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $1.73 / $1.88
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $2.36 / $3.54
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.80 / $0.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.36 / $95.00 / $95.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $1.52 / $1.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $2.36 / $3.54
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.80 / $0.80
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $95.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.52 / $1.82