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South Dakota rates for HCPCS L2188

Addition To Lower Extremity Fracture Orthosis Quadrilateral Brim

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.43 / $234.43 / $234.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.95 / $230.64 / $234.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.27 / $218.27 / $371.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.13 / $391.13 / $488.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.64 / $389.78 / $1,743.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.41 / $224.43 / $400.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$308.58 / $371.14 / $647.49
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.97 / $376.36 / $709.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.44 / $329.49 / $391.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.80 / $186.87 / $280.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.65 / $330.65 / $330.65