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South Dakota rates for HCPCS A4217

Sterile water/saline, 500 ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.79 / $2.79 / $2.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.79 / $2.79 / $3.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.50 / $6.50 / $8.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.25 / $6.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.11 / $4.76 / $8.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.75 / $3.49 / $21.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.17 / $4.99 / $6.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.79 / $4.82 / $6.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.52 / $4.38 / $5.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.46 / $1.90 / $3.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.94 / $3.94 / $3.94