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South Dakota rates for HCPCS L0984

Protective Body Sock Prefabricated Off-The- Shelf Each (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.65 / $56.65 / $56.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.32 / $51.32 / $56.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.72 / $36.72 / $86.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.50 / $94.50 / $118.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.66 / $86.73 / $353.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $47.85 / $86.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.80 / $86.35 / $129.43
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.73 / $87.57 / $165.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.61 / $73.31 / $87.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.34 / $37.45 / $59.81
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.93 / $76.93 / $76.93