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South Dakota rates for HCPCS J7640

Formoterol Inhalation Solution Compounded Product Administered Through Dme Unit Dose Form 12 Micrograms

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.95 / $2.95 / $2.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.36 / $2.45 / $2.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $1.52 / $1.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.22 / $4.50 / $7.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.52 / $1.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $0.87 / $2.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.34 / $1.52 / $1.67