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South Dakota rates for HCPCS L2390

Addition to lower extremity, offset knee joint, each joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.69 / $85.69 / $85.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.47 / $81.47 / $112.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.77 / $79.77 / $135.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.88 / $142.88 / $178.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.89 / $166.99 / $647.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.86 / $94.14 / $154.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.79 / $135.65 / $236.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.83 / $140.16 / $294.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.16 / $160.58 / $190.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.17 / $82.03 / $136.72
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.85 / $120.85 / $120.85