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South Dakota rates for HCPCS A4257

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $10.96 / $10.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $10.96 / $14.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.30 / $26.30 / $33.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $20.42 / $25.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.30 / $18.20 / $24.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $8.91 / $89.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $19.50 / $19.50
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $16.22 / $31.62
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $17.78 / $23.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.89 / $7.59 / $17.78
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $17.78 / $17.78