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South Dakota rates for HCPCS J7612

Levalbuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.27 / $0.27 / $0.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.27 / $0.27 / $0.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.82 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.30 / $0.45
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.25 / $0.35 / $0.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.27 / $0.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.27 / $0.27 / $0.30
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.30
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.33