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South Dakota rates for HCPCS A4625

Tracheostomy Care Kit For New Tracheostomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $6.17 / $6.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.72 / $5.62 / $6.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $7.17 / $9.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.48 / $11.25 / $14.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.62 / $10.40 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.28 / $5.24 / $10.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.51 / $10.40 / $13.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.51 / $10.40 / $19.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.87 / $8.02 / $9.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.21 / $4.73 / $7.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.82 / $7.82 / $7.82