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South Dakota rates for HCPCS A0425

Ground mileage, per statute mile

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$688.24 / $688.24 / $688.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.93 / $4.93 / $5.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.88 / $10.88 / $13.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.16 / $21.78 / $26.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $4.57 / $8.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.66 / $6.66 / $8.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.29 / $19.84 / $22.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.57 / $7.62 / $10.73
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.00 / $14.00 / $14.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.00 / $14.00 / $14.00