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South Dakota rates for HCPCS L2275

Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $109.65 / $109.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $93.33 / $131.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $102.33 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $181.97 / $229.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $169.82 / $316.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $112.20 / $912.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $194.98 / $199.53
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $199.53 / $199.53
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $302.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $165.96 / $223.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $83.18 / $165.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83