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South Dakota rates for HCPCS L2525

Addition to lower extremity, thigh/weight bearing, ischial containment/narrow M-L brim molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.20 / $954.20 / $954.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$945.12 / $954.20 / $1,055.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$888.38 / $888.38 / $1,654.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,592.25 / $1,608.17 / $1,990.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,055.53 / $1,767.92 / $7,400.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.15 / $984.23 / $1,650.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,376.06 / $1,654.94 / $2,635.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,355.41 / $1,678.24 / $3,162.55
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,287.98 / $1,507.90 / $1,792.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.44 / $799.31 / $1,283.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,474.40 / $1,474.40 / $1,474.40