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South Dakota rates for HCPCS L0861

Addition To Halo Procedure Replacement Liner/Interface Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.44 / $180.44 / $180.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.32 / $179.47 / $180.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.00 / $168.00 / $284.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.13 / $304.14 / $376.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179.47 / $303.30 / $1,209.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.59 / $167.34 / $283.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$236.34 / $284.23 / $445.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.79 / $288.23 / $543.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.99 / $256.39 / $304.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.45 / $174.63 / $298.66
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.22 / $253.22 / $253.22