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South Dakota rates for HCPCS A4220

Refill Kit For Implantable Infusion Pump (Special Coverage Instructions Apply. See Cim: 60-14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.00 / $52.00 / $65.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.00 / $39.39 / $48.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.65 / $33.79 / $54.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.53 / $59.85 / $59.85
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $57.53 / $59.85
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60