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South Dakota rates for HCPCS L3390

Outflare Wedge (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.52 / $41.52 / $41.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.36 / $41.31 / $41.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.99 / $43.99 / $65.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.38 / $69.38 / $86.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.95 / $69.81 / $278.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.07 / $38.51 / $65.22
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.38 / $65.41 / $102.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.57 / $66.33 / $125.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.40 / $59.01 / $70.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.85 / $30.14 / $50.24
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.49 / $56.49 / $56.49