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South Dakota rates for HCPCS A4221

Supplies for maintenance of noninsulin drug infusion catheter, per week (list drugs separately)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.02 / $17.02 / $17.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.02 / $17.48 / $19.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.50 / $37.50 / $46.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.25 / $29.54 / $36.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.19 / $32.43 / $37.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.69 / $19.39 / $125.45
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.16 / $31.93 / $40.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $30.97 / $52.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.46 / $25.95 / $33.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.69 / $13.15 / $21.92
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.34 / $25.34 / $25.34