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South Dakota rates for HCPCS L2620

Addition To Lower Extremity Pelvic Control Hip Joint Heavy Duty Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.30 / $209.30 / $209.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.91 / $209.30 / $238.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.22 / $188.22 / $418.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.13 / $352.62 / $436.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$259.91 / $355.95 / $1,633.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.01 / $192.01 / $417.13
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.86 / $418.35 / $578.04
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.64 / $424.26 / $799.49
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.27 / $294.16 / $349.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.66 / $175.32 / $250.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.71 / $372.71 / $372.71