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South Dakota rates for HCPCS L8613

Ossicula Implant (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$343.62 / $343.62 / $343.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.33 / $301.39 / $343.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.27 / $274.27 / $358.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.41 / $475.50 / $594.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.77 / $509.35 / $1,565.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.95 / $205.30 / $372.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$298.05 / $358.45 / $592.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.57 / $363.48 / $684.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.44 / $301.39 / $358.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.56 / $205.30 / $273.49
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.86 / $325.86 / $325.86