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South Dakota rates for HCPCS L8628

Cochlear Implant, Extern Controller Component, Replace

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,285.25 / $1,285.25 / $1,285.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,171.21 / $1,285.25 / $1,493.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$843.35 / $843.35 / $1,650.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,779.00 / $1,779.00 / $2,223.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,076.76 / $2,523.86 / $7,017.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$609.24 / $1,017.24 / $1,715.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,372.50 / $1,650.68 / $2,590.04
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,351.91 / $1,673.91 / $3,154.39
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,275.60 / $1,493.41 / $1,775.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.21 / $897.78 / $1,534.44
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,500.62 / $1,500.62 / $1,500.62