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South Dakota rates for HCPCS L2624

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$326.64 / $326.64 / $326.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.02 / $276.44 / $326.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.02 / $291.02 / $484.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.54 / $544.88 / $681.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.72 / $430.98 / $2,011.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.63 / $237.80 / $482.65
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$402.49 / $484.06 / $715.91
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.44 / $490.88 / $925.05
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.18 / $364.32 / $433.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.72 / $217.13 / $330.60
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.25 / $431.25 / $431.25