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South Dakota rates for HCPCS L2375

Addition To Lower Extremity Torsion Control Ankle Joint And Half Solid Stirrup

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.01 / $103.01 / $103.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.23 / $87.02 / $103.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.21 / $104.21 / $151.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.75 / $171.75 / $214.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.81 / $147.06 / $670.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.71 / $81.14 / $151.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.54 / $151.00 / $244.29
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.68 / $153.12 / $288.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.18 / $124.31 / $147.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.72 / $74.09 / $148.25
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.52 / $134.52 / $134.52