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South Dakota rates for HCPCS L2768

Orthotic side bar disconnect device, per bar

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.07 / $109.07 / $109.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.15 / $108.49 / $109.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.06 / $99.06 / $171.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.88 / $181.88 / $227.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.49 / $183.35 / $730.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.23 / $101.17 / $171.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.90 / $171.86 / $269.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.76 / $174.29 / $328.42
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.38 / $154.99 / $184.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.78 / $79.18 / $131.97
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.12 / $153.12 / $153.12