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South Dakota rates for HCPCS J7677

Revefenacin inhalation solution, FDA-approved final product, noncompounded, administered through DME, 1 mcg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.24 / $0.32 / $85.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.17 / $0.19 / $0.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.23 / $0.23 / $0.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.23 / $0.50
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
$0.19 / $0.19 / $0.21
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.19 / $0.21