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South Dakota rates for HCPCS L2840

Addition to lower extremity orthosis, tibial length sock, fracture or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $36.31 / $36.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $30.90 / $42.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $31.62 / $57.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $75.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $50.12 / $91.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $32.36 / $323.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $56.23 / $56.23
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $57.54 / $57.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $46.77 / $89.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $48.98 / $64.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $28.84 / $56.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $50.12 / $50.12