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South Dakota rates for HCPCS L2425

Addition To Knee Joint Disc Or Dial Lock For Adjustable Knee Flexion Each Joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.01 / $120.01 / $120.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.92 / $107.95 / $120.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.24 / $104.24 / $189.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.25 / $200.25 / $250.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.38 / $201.75 / $804.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.56 / $110.42 / $188.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.16 / $189.02 / $296.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.81 / $191.69 / $361.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.66 / $170.54 / $202.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.27 / $87.13 / $145.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.40 / $168.40 / $168.40