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South Dakota rates for HCPCS L3254

Nonstandard size or width

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.05 / $14.05 / $14.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.05 / $14.05 / $17.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.75 / $10.75 / $10.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.85 / $10.75 / $53.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.09 / $30.13 / $48.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.90 / $50.90 / $56.21
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.97 / $53.97 / $53.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.01 / $53.97 / $56.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.90 / $50.90 / $50.90
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.80 / $46.80 / $46.80