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South Dakota rates for HCPCS A4222

Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.13 / $33.13 / $33.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.05 / $33.13 / $37.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.00 / $71.00 / $88.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.50 / $56.06 / $69.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.78 / $63.07 / $72.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.39 / $36.79 / $241.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.51 / $64.00 / $78.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.71 / $60.21 / $103.85
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.39 / $53.76 / $63.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.39 / $25.28 / $42.13
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.27 / $49.27 / $49.27