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South Dakota rates for HCPCS A4623

Tracheostomy Inner Cannula. (Rvsd 1/1/04) Ecial Coverage Instructions Apply. See Cim: 65-16)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.84 / $5.84 / $5.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.58 / $6.27 / $6.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $6.62 / $8.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.50 / $10.50 / $13.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.27 / $10.60 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.65 / $5.83 / $9.85
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $8.57 / $13.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.75 / $8.68 / $16.39
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.63 / $8.94 / $10.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.65 / $7.61 / $10.53
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.40 / $7.40 / $7.40