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South Dakota rates for HCPCS L3995

Addition to upper extremity orthosis, sock, fracture or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.28 / $31.28 / $31.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.95 / $22.64 / $31.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $29.97 / $39.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.13 / $52.13 / $65.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.64 / $41.64 / $196.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.36 / $22.98 / $42.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.97 / $39.65 / $69.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.47 / $40.21 / $75.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.07 / $35.20 / $41.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.36 / $28.72 / $51.77
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.25 / $34.25 / $34.25