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South Dakota rates for HCPCS L2520

Addition to lower extremity, thigh/weight bearing, quadri-lateral brim, custom fitted

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$449.99 / $449.99 / $449.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.02 / $379.70 / $449.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$324.30 / $324.30 / $570.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.75 / $750.75 / $938.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.70 / $641.69 / $2,792.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.29 / $354.06 / $615.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$474.69 / $570.90 / $995.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$473.48 / $578.92 / $1,090.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.32 / $542.42 / $644.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.73 / $302.08 / $615.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.62 / $508.62 / $508.62