go back

South Dakota rates for HCPCS L2627

Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,789.23 / $1,789.23 / $1,789.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,213.25 / $1,760.31 / $1,789.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,206.80 / $1,206.80 / $2,124.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,985.38 / $2,985.38 / $3,731.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,486.15 / $2,615.30 / $10,169.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$965.36 / $1,474.42 / $2,543.73
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,766.44 / $2,124.44 / $3,706.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,923.51 / $2,195.03 / $4,616.43
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,147.94 / $2,514.73 / $2,989.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$802.93 / $1,605.85 / $2,703.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,892.68 / $1,892.68 / $1,892.68