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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
$2.00 / $2.00 / $4.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $3.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.29 / $3.39 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $1.95 / $5.50
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.34 / $13.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.63 / $2.63 / $2.63
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.40 / $2.40 / $2.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $2.19 / $6.92
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.75 / $2.75 / $2.75
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $2.75 / $3.02