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South Dakota rates for HCPCS A0422

Ambulance (ALS or BLS) oxygen and oxygen supplies, life sustaining situation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.29 / $25.29 / $27.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $37.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.66 / $17.75 / $32.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.14 / $34.14 / $44.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.75 / $26.90 / $32.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00