go back

South Dakota rates for HCPCS L3640

Transfer Of An Orthosis From One Shoe To Another Dennis Browne Splint (Riveton) Both Shoes (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.22 / $36.22 / $36.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.57 / $35.99 / $36.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.33 / $36.33 / $57.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.38 / $60.98 / $75.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.01 / $60.82 / $242.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.98 / $33.56 / $56.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.42 / $57.04 / $89.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.72 / $57.85 / $109.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.92 / $51.42 / $61.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.18 / $27.08 / $55.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.26 / $49.26 / $49.26