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South Dakota rates for HCPCS J7614

Levalbuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.25 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.18
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.10 / $0.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.10 / $0.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.10 / $0.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.10
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.09
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.10