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South Dakota rates for HCPCS A5113

Leg Strap; Latex Replacement Only Per Set (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.20 / $4.20 / $4.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.83 / $4.20 / $5.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.96 / $3.96 / $7.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.15 / $7.50 / $9.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.49 / $6.90 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.23 / $4.46 / $7.53
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $7.24 / $9.49
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.67 / $7.35 / $13.85
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.67 / $5.47 / $6.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $3.29 / $4.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $5.92 / $5.92