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South Dakota rates for HCPCS 21084

Impression and custom preparation; speech aid prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,193.01 / $1,193.01 / $1,569.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,003.84 / $1,324.01 / $3,735.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,488.62 / $3,423.17 / $4,545.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,696.49 / $2,438.17 / $4,067.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,868.06 / $3,926.25 / $11,641.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,607.63 / $3,141.04 / $4,063.18
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,639.60 / $3,177.82 / $4,063.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,753.64 / $2,352.13 / $3,079.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,656.85 / $2,927.34 / $4,553.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,333.40 / $2,855.00 / $3,737.60