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South Dakota rates for HCPCS 21086

Impression and custom preparation; auricular prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,380.38 / $1,584.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,584.89 / $2,818.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $3,715.35 / $4,677.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $2,630.27 / $4,466.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $3,715.35 / $11,748.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $3,388.44 / $4,073.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $3,467.37 / $4,168.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,630.27 / $3,235.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,818.38 / $4,677.35
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $3,090.30 / $3,801.89