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South Dakota rates for HCPCS L8415

Prosthetic Sheath Upper Limb Each (Special Coverage Instructions Apply. See Mcm: 2133)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.55 / $21.55 / $21.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.55 / $22.79 / $27.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.30 / $16.30 / $32.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.30 / $37.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.79 / $33.61 / $134.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.32 / $18.89 / $33.38
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.71 / $32.11 / $49.37
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.29 / $32.56 / $61.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.69 / $27.74 / $32.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.05 / $17.11 / $23.62
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.61 / $28.61 / $28.61