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South Dakota rates for HCPCS J7620

Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, FDA-approved final product, noncompounded, administered through DME

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.20 / $0.20 / $0.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.17 / $0.20 / $1.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.22 / $0.48 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.17 / $0.20 / $0.30
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.16 / $0.22 / $0.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.16 / $0.21 / $0.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.21 / $0.21 / $0.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.20 / $0.22
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.20 / $0.20 / $0.20
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.20 / $0.22