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South Dakota rates for HCPCS L6570

Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $5,128.61 / $5,128.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $4,168.69 / $5,888.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $6,025.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,079.46 / $7,079.46 / $8,912.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $6,165.95 / $16,982.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $3,981.07 / $34,673.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $5,888.44 / $5,888.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $6,025.60 / $6,025.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $11,220.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $6,309.57 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $3,981.07 / $6,165.95
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $5,248.07