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South Dakota rates for HCPCS L7900

Male Vacuum Erection System (Rvsd 1/01/03)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.10 / $243.10 / $243.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.29 / $243.10 / $266.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$409.07 / $409.07 / $409.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.10 / $607.88 / $759.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.10 / $492.40 / $1,416.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.56 / $272.11 / $441.54
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$364.98 / $435.50 / $614.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.98 / $558.37 / $1,048.64
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.40 / $546.40 / $562.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.52 / $230.98 / $320.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.20 / $532.20 / $532.20