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South Dakota rates for HCPCS L4010

Replace trilateral socket brim

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.40 / $672.40 / $672.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.07 / $560.26 / $672.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$626.01 / $626.01 / $931.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,044.73 / $1,122.00 / $1,402.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$578.83 / $946.84 / $4,031.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.52 / $522.41 / $928.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$774.68 / $931.68 / $1,450.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$763.07 / $944.80 / $1,780.43
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$683.64 / $800.37 / $951.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.33 / $440.06 / $967.72
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$804.63 / $804.63 / $804.63