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South Dakota rates for HCPCS L2540

Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.91 / $379.91 / $379.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.20 / $369.56 / $379.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$297.62 / $297.62 / $523.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.75 / $633.75 / $792.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.56 / $612.83 / $2,544.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.37 / $344.59 / $565.30
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$435.64 / $523.92 / $914.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.82 / $531.30 / $1,001.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.94 / $527.94 / $627.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.06 / $344.59 / $721.72
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.77 / $466.77 / $466.77