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South Dakota rates for HCPCS L8658

Interphalangeal joint spacer, silicone or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.83 / $306.83 / $306.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.91 / $306.83 / $476.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$228.90 / $228.90 / $402.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$424.50 / $424.50 / $530.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.04 / $682.08 / $1,907.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.97 / $289.83 / $469.95
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.05 / $402.95 / $702.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.84 / $416.34 / $875.63
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.41 / $476.98 / $566.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.30 / $324.62 / $406.12
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.99 / $358.99 / $358.99