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South Dakota rates for HCPCS A4629

Tracheostomy care kit for established tracheostomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.15 / $4.15 / $4.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $4.42 / $5.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.29 / $3.90 / $7.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.50 / $7.50 / $9.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.42 / $7.47 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.58 / $3.94 / $7.38
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.92 / $7.11 / $9.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.56 / $7.21 / $13.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.39 / $6.31 / $7.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.16 / $3.23 / $5.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.14 / $6.14 / $6.14