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South Dakota rates for HCPCS L2265

Addition To Lower Extremity Long Tongue Stirrup

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.54 / $112.54 / $112.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.07 / $90.70 / $112.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.22 / $106.22 / $148.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.13 / $187.88 / $234.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.54 / $153.28 / $729.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.86 / $84.57 / $157.47
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.85 / $148.94 / $254.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.99 / $151.05 / $284.64
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.67 / $129.57 / $154.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.83 / $77.22 / $186.27
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.69 / $132.69 / $132.69