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South Dakota rates for HCPCS A5114

Leg strap; foam or fabric, replacement only, per set

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.89 / $7.89 / $7.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.89 / $8.55 / $8.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.95 / $7.51 / $11.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.25 / $14.25 / $17.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.40 / $14.45 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.99 / $8.84 / $13.71
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.72 / $13.71 / $18.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.66 / $13.71 / $26.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.44 / $12.21 / $14.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.15 / $6.24 / $10.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.57 / $9.57 / $9.57