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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
$5,105.93 / $5,105.93 / $5,105.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,182.71 / $5,105.93 / $6,166.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,943.38 / $3,943.38 / $5,894.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,066.88 / $7,066.88 / $8,833.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,886.98 / $6,413.17 / $27,719.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,471.94 / $4,156.60 / $6,314.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,901.58 / $5,894.99 / $10,081.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,337.46 / $5,977.96 / $11,320.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,267.16 / $6,166.52 / $7,329.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,052.07 / $3,494.42 / $5,250.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,251.90 / $5,251.90 / $5,251.90