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South Dakota rates for HCPCS L2785

Addition to lower extremity orthosis, drop lock retainer, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.81 / $24.81 / $24.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.93 / $24.41 / $24.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.10 / $23.10 / $41.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.25 / $41.66 / $51.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.04 / $41.25 / $190.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.23 / $23.75 / $42.38
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.85 / $41.90 / $68.51
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.32 / $42.50 / $80.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.78 / $34.86 / $41.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.95 / $20.78 / $31.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.33 / $37.33 / $37.33