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South Dakota rates for HCPCS A4562

Pessary Reusable Non Rubber Any Type (Desc Rsvd 4/1/2024)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.37 / $45.37 / $45.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.94 / $45.37 / $102.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.91 / $44.91 / $77.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.50 / $82.50 / $103.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.17 / $78.33 / $305.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.65 / $45.83 / $80.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.70 / $77.84 / $121.92
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.74 / $78.93 / $148.72
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.98 / $70.20 / $83.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.82 / $35.86 / $59.78
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.68 / $63.68 / $63.68