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South Dakota rates for HCPCS L2190

Addition To Lower Extremity Fracture Orthosis Waist Belt

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.41 / $71.41 / $71.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.33 / $69.66 / $71.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.48 / $61.48 / $114.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.25 / $119.25 / $149.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.06 / $117.73 / $503.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.60 / $64.95 / $116.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.12 / $114.39 / $188.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.68 / $116.00 / $218.61
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $99.51 / $118.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.43 / $57.27 / $87.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.91 / $101.91 / $101.91