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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
$109.65 / $109.65 / $109.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $87.10 / $114.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $173.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $181.97 / $229.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $158.49 / $295.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $100.00 / $794.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $169.82 / $173.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $173.78 / $173.78
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $144.54 / $281.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $158.49 / $208.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $79.43 / $165.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $154.88 / $154.88