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South Dakota rates for HCPCS L2640

Addition to lower extremity, pelvic control, band and belt, bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.06 / $263.06 / $263.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.83 / $258.80 / $263.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$236.57 / $236.57 / $416.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.75 / $438.75 / $548.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.80 / $437.37 / $2,077.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.83 / $241.33 / $449.34
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.28 / $416.45 / $726.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.08 / $422.32 / $795.85
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.80 / $369.72 / $439.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.88 / $209.69 / $314.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.02 / $371.02 / $371.02