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South Dakota rates for HCPCS L2397

Addition to lower extremity orthosis, suspension sleeve

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.18 / $102.18 / $102.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.04 / $95.36 / $102.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.98 / $92.98 / $166.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.63 / $172.33 / $213.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.73 / $166.49 / $659.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.80 / $92.47 / $173.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.84 / $166.98 / $242.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.75 / $169.33 / $319.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.01 / $141.66 / $168.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.46 / $75.73 / $150.27
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.76 / $148.76 / $148.76