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South Dakota rates for HCPCS L2622

Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.39 / $266.39 / $266.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.16 / $236.17 / $266.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.87 / $215.87 / $399.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.38 / $444.38 / $555.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.22 / $399.13 / $1,848.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.63 / $220.22 / $410.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.20 / $399.52 / $662.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.24 / $405.16 / $763.49
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.17 / $337.38 / $401.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.94 / $181.20 / $287.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.94 / $355.94 / $355.94