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South Dakota rates for HCPCS L2250

Addition To Lower Extremity Foot Plate Molded To Patient Model Stirrup Attachment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$279.63 / $279.63 / $279.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.47 / $296.27 / $323.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.60 / $252.60 / $518.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.50 / $518.78 / $583.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$322.30 / $515.36 / $2,114.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.34 / $302.06 / $503.20
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$431.37 / $518.78 / $768.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$424.90 / $526.09 / $991.40
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.29 / $462.78 / $550.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.37 / $235.29 / $394.02
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.19 / $462.19 / $462.19