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South Dakota rates for HCPCS L6370

Interscapular thoracic, passive restoration (shoulder cap only)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,476.02 / $2,476.02 / $2,476.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,111.48 / $2,380.65 / $2,476.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,523.27 / $1,523.27 / $2,975.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,107.48 / $3,427.13 / $4,283.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,972.09 / $2,901.14 / $12,771.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$971.18 / $1,621.58 / $3,092.54
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,474.40 / $2,975.89 / $4,678.18
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,437.28 / $3,017.78 / $5,686.88
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,033.44 / $2,380.65 / $2,829.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$952.26 / $1,621.58 / $2,160.32
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,651.24 / $2,651.24 / $2,651.24