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South Dakota rates for HCPCS L2820

Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.98 / $67.98 / $67.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.75 / $61.46 / $89.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.18 / $72.18 / $107.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.25 / $113.25 / $141.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.29 / $133.32 / $556.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.13 / $86.70 / $137.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.49 / $107.61 / $187.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.44 / $111.20 / $233.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.81 / $127.39 / $151.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.22 / $56.95 / $108.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.87 / $95.87 / $95.87