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South Dakota rates for HCPCS J2545

Pentamidine isethionate, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose form, per 300 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.73 / $69.73 / $69.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.73 / $69.73 / $99.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.00 / $81.81 / $101.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.26 / $139.21 / $350.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.73 / $82.37 / $123.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.26 / $98.84 / $141.66
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.03 / $111.27 / $172.06
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.30 / $76.30 / $140.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.73 / $69.73 / $78.09
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.37 / $82.37 / $82.37
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.37 / $82.37 / $90.14