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South Dakota rates for HCPCS L8420

Prosthetic Sock Multiple Ply Below Knee Each (Special Coverage Instructions Apply. See Mcm: 2133)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.09 / $21.09 / $21.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.18 / $21.09 / $22.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.29 / $16.29 / $28.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.25 / $29.54 / $36.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.47 / $30.26 / $125.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.30 / $17.55 / $28.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.65 / $28.45 / $44.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.29 / $28.84 / $54.35
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.47 / $22.79 / $27.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.11 / $12.90 / $19.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.34 / $25.34 / $25.34