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South Dakota rates for HCPCS L8612

Aqueous Shunt (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$800.30 / $800.30 / $800.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$569.60 / $788.42 / $1,039.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$451.71 / $451.71 / $802.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,029.14 / $1,107.75 / $1,384.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$569.26 / $1,332.43 / $3,676.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.64 / $537.04 / $866.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$667.49 / $802.77 / $1,400.50
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$688.19 / $814.07 / $1,534.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$673.44 / $788.42 / $937.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.08 / $485.45 / $671.30
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$715.19 / $715.19 / $715.19