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South Dakota rates for HCPCS A4257

Replacement lens shield cartridge for use with laser skin piercing device, each

Facilitymedian $17 · 10th–90th $11–$260%20%10th90th$17Professionalmedian $12 · 10th–90th $10–$240%20%10th90th$12$10.0$20.0$50.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.96 / $10.96 / $10.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $10.96 / $23.99
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.30 / $26.30 / $33.11
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.42 / $20.42 / $25.70
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.30 / $19.05 / $24.55
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.08 / $7.59 / $89.13
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.50 / $19.50 / $19.50
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.22 / $16.22 / $31.62
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.98 / $17.78 / $23.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $8.91 / $19.95
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17.78 / $17.78 / $17.78