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South Dakota rates for HCPCS J7606

Formoterol fumarate, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose form, 20 mcg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.73 / $2.73 / $2.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.38 / $2.73 / $2.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $2.16 / $2.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $5.40 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.67 / $1.97 / $5.46
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.36 / $12.45
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.15 / $7.77 / $14.22
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.98 / $2.98 / $2.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.73 / $2.73 / $3.06
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.97 / $1.97 / $1.97
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.97 / $1.97 / $2.15