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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
$7.08 / $7.08 / $7.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $7.08 / $10.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $7.59 / $12.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $14.13 / $17.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.32 / $13.49 / $23.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $7.08 / $107.15
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $13.80 / $13.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $12.02 / $12.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $9.77 / $22.39
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $12.59 / $16.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $6.31 / $12.59
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.55 / $9.55 / $9.55