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South Dakota rates for HCPCS L2570

Addition to lower extremity, pelvic control, hip joint, Clevis type two-position joint, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$372.85 / $372.85 / $372.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.82 / $372.85 / $387.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.13 / $347.13 / $679.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.13 / $628.35 / $777.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$421.89 / $619.92 / $2,901.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.78 / $356.94 / $670.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.65 / $679.10 / $1,029.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$556.17 / $688.65 / $1,297.73
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.60 / $524.03 / $622.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.61 / $312.33 / $446.18
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.01 / $605.01 / $605.01